Intrathoracic omental herniation through the esophageal hiatus: report of a case

We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.