Radiology glossary

What does "hiatal hernia" mean on your scan?

Part of: Abdomen findings, explained

Full explainer: Hiatal Hernia — What It Means on Your Report

Part of the stomach has pushed upward through the diaphragm's opening into the chest — a remarkably common finding, especially with age. The diaphragm has a natural hole (the hiatus) where the esophagus passes from chest to abdomen; when that opening loosens, the top of the stomach can slide through it. The commonest kind, the sliding hiatal hernia, moves up and down and is found in a large share of adults over 50 — most of whom never know it is there. It is associated with reflux symptoms because the displaced stomach can weaken the valve between esophagus and stomach, letting acid wash upward: heartburn, regurgitation, and sometimes a chronic cough. But many hiatal hernias cause no symptoms at all and are spotted incidentally on chest or abdominal imaging. Larger or less common types, where more of the stomach migrates into the chest, deserve closer attention. For the typical small sliding hernia, the finding is background anatomy that your doctor interprets alongside any reflux symptoms.

What it means on Ultrasound

Ultrasound is not the test for hiatal hernia — the stomach's position at the diaphragm is poorly seen through the ribs and air-filled structures. The diagnosis belongs to CT, contrast X-ray studies, and endoscopy. Ultrasound remains a workhorse for many abdominal complaints — gallbladder, liver, kidneys, and free fluid are its home territory — but the anatomy involved in this finding sits beyond what it can assess reliably. If your records pair this diagnosis with an abdominal ultrasound, it was most likely evaluating a neighboring organ or a different symptom. Each test in the workup answers its own question, and your doctor can map them for you.

What radiologists look at next

For a hiatal hernia, the radiologist notes its type and size: a small sliding hernia versus a larger paraesophageal hernia where part of the stomach sits alongside the esophagus in the chest. They check for complications — rotation of the stomach, obstruction, or signs of compromised blood supply — which are uncommon but important in large hernias. The esophagus is surveyed for inflammation or narrowing that often accompanies reflux. The report distinguishes the common, usually incidental sliding hernia from the less common types that merit specialist attention.

Where it commonly shows up

• diaphragm
• gastroesophageal junction
• chest
• upper abdomen

Questions to ask your doctor

• What type and size is my hiatal hernia?
• Could it be contributing to my reflux symptoms?
• Does it need treatment, or just monitoring?
• What symptoms would suggest it is getting worse?
• Should I see a specialist?

Common questions

What does a hiatal hernia feel like?

Many cause no symptoms at all. When symptoms occur, they are usually reflux-related: heartburn, acid regurgitation, chest discomfort, or sometimes a chronic cough or hoarseness. Large hernias can occasionally cause difficulty swallowing or chest pressure. Your doctor can assess whether your symptoms fit the hernia.

What causes a hiatal hernia?

Usually a gradual loosening of the diaphragm's esophageal opening with age, sometimes hastened by increased abdominal pressure — from excess weight, pregnancy, chronic coughing, or heavy lifting. It is an anatomical change, not something anyone did wrong, and it is very common in older adults.

Does a hiatal hernia need surgery?

Rarely — the common small sliding hernia is managed by addressing reflux symptoms, not by fixing the anatomy. Surgery is reserved for large paraesophageal hernias, complications, or reflux that does not respond to simpler measures. Your doctor will advise based on the hernia's type and your symptoms.

What is the difference between a sliding and a paraesophageal hiatal hernia?

A sliding hernia — by far the common type — is when the junction where the esophagus meets the stomach slides upward through the diaphragm, and it often slides back down; it is strongly associated with reflux because the anti-reflux valve is displaced. A paraesophageal hernia is different and less common: the junction stays in place while a portion of the stomach squeezes up alongside the esophagus through the diaphragmatic opening. Paraesophageal hernias carry risks the sliding type does not, including twisting or loss of blood supply to the trapped stomach portion, which is why they are followed more closely and repaired surgically more often. Most reports specify the type, and mixed hernias with features of both also occur — ask your doctor which pattern your report describes.

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