Incidence and Management of Hiatal Hernia Found on Imaging During Lung Cancer Screening


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Presentation: 8:17

Mentor: Olugbenga Okusanya, MD, Thoracic Surgery, Thomas Jefferson University Hospital

Awards: 2021 IASLC Staging Project- 9th edition, 2022 Saligman Family Grant


Background: Lung cancer screening has led to the discovery of many incidental findings including hiatal hernias (HH). However, the clinical significance and work up of these HH varies widely and there is no standardized approach towards follow-up studies or interventions. Therefore, we sought to identify the incidence, symptoms, and management of incidentally found HH on lung cancer screening CT scans.

Methods: We conducted a retrospective chart review of patients who had HH incidentally found on their lung cancer screening CT scans, at our institution between June 2021 and January 2022. We then analyzed the collected data to determine the incidence of HH in lung cancer screening patients, presence of symptoms, and management of these HH.

Results: 638 patients underwent lung cancer screening, of which 8.8% (n= 56) were found to have HH. Although 64.28% (n= 36) were symptomatic, 51.79% had not seen a gastroenterologist (n= 29) and 64.29% never had prior esophagogastroduodenoscopy (n= 36). Of the patients with HH, 23.21% (n= 13) were evaluated by a thoracic surgeon based on symptoms or type of HH, and almost half (n=6) of them qualified for surgical intervention. Patients not eligible for surgical intervention were referred to gastroenterology for follow-up.

Conclusions: Hiatal hernias are common incidental findings on lung cancer screening CT scans. If left untreated, they can worsen patients’ quality of life and present with complications. Therefore, it is important to address hiatal hernias in a timely fashion and establish proper follow-up and treatment plan as needed.



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