Yes. A CT scan can detect a hiatal hernia by showing part of the stomach extending through the opening in the diaphragm into the chest. It is often found by chance when a CT is performed for another reason. However, CT is not always the main test used to investigate suspected hiatal hernia; a barium swallow or upper endoscopy may provide information better suited to the question.
How Can a CT Scan Show a Hiatal Hernia?
A hiatal hernia occurs when the upper part of the stomach moves through an opening in the diaphragm, the muscle that separates the chest from the abdomen. A CT scan uses X-rays to create detailed cross-sectional images of the body's internal structures. These images can show the position of the stomach in relation to the diaphragm and reveal when part of the stomach has moved into the chest.
According to the Merck Manual Professional Edition, hiatal hernias are often discovered incidentally on chest or abdominal CT scans. This means the scan was originally ordered to investigate another concern, but the images revealed the hernia as an additional finding. A radiologist may describe it in the report even when the scan was not specifically requested to investigate a hiatal hernia.
Can a CT Scan Miss a Hiatal Hernia?
Although CT can detect a hiatal hernia, it does not necessarily identify every hernia in every situation. Small sliding hiatal hernias can be particularly difficult to assess because the junction between the esophagus and stomach may move above and below the diaphragm at different times. A single scan captures the anatomy during that particular examination.
The Cleveland Clinic explains that, in a sliding hiatal hernia, the connection between the esophagus and stomach can move upward through the opening in the diaphragm and then slide back down. This movement helps explain why further testing may sometimes be useful when symptoms continue but a CT scan has not clearly answered the diagnostic question.
A CT report that does not mention a hiatal hernia does not always settle the issue. If a healthcare professional suspects one based on the symptoms, medical history, or other findings, a different examination may be appropriate.
Which Tests Can Confirm a Hiatal Hernia Besides CT?
CT is useful for identifying a hiatal hernia, but it is not always the preferred examination when the main goal is to evaluate how the esophagus and stomach connect. The Merck Manual Professional Edition identifies a barium swallow as the diagnostic test of choice for a hiatal hernia. Upper endoscopy and specialized esophageal testing may also be used, depending on the clinical question.
Barium Swallow
A barium swallow, also called an esophagram, uses X-ray imaging after a person swallows a liquid containing barium. The liquid outlines the upper digestive tract, allowing the healthcare team to examine the esophagus and stomach as the liquid passes through them. This can help show the position of the stomach relative to the diaphragm and identify a hiatal hernia.
Mayo Clinic describes an upper digestive system X-ray using a swallowed contrast liquid as one of the tests used to investigate a suspected hiatal hernia. This examination can provide information about the structure and passage of material through the upper digestive tract.
Upper Endoscopy
An upper endoscopy uses a thin, flexible tube with a small camera to examine the inside of the esophagus and stomach. It may reveal a hiatal hernia and also allows the clinician to look for inflammation or other changes in the digestive tract. Unlike CT or a barium swallow, endoscopy directly examines the lining of these organs.
The Cleveland Clinic lists upper endoscopy among the tests that can identify a hiatal hernia. The choice between endoscopy, a barium swallow, CT, or a combination of tests depends on what the healthcare professional needs to find out.
Esophageal Manometry
In some cases, a healthcare professional may recommend esophageal manometry. This test measures the muscle contractions and pressure involved in swallowing. It is not a CT scan and does not directly examine the digestive tract with a camera, but it may provide additional information when a swallowing or movement problem needs further assessment.
What Does a Hiatal Hernia Finding on a CT Report Mean?
A hiatal hernia reported on CT does not automatically mean that treatment is necessary. Some hernias cause no noticeable problems and are discovered only because imaging was performed for another reason. When symptoms are present, a healthcare professional considers the scan findings alongside the person's medical history and experiences to determine whether further evaluation or treatment is appropriate.
According to Mayo Clinic, many people with a hiatal hernia do not have symptoms and do not need treatment. When heartburn or acid reflux is frequent, however, further assessment may help determine whether the hernia is relevant to the symptoms and what approach may be helpful.
The wording of a CT report also matters. A report may mention a small hiatal hernia as an incidental finding without identifying it as the reason for the scan or the person's symptoms. The ordering healthcare professional can explain the significance of the finding and whether additional investigation is needed.
When Should You Discuss CT Findings With a Healthcare Professional?
Arrange a medical appointment if you have persistent or worsening heartburn, repeated reflux symptoms, or discomfort that interferes with daily activities. A clinician can review the CT report and decide whether another test would provide useful information. Chest pain should not automatically be attributed to a hiatal hernia, because it can have other causes that may need prompt assessment.
The NHS advises seeking medical assessment when reflux or indigestion is accompanied by concerns such as difficulty swallowing, frequent vomiting, blood in vomit, upper abdominal pain, or unexplained weight loss. These findings deserve evaluation rather than being assumed to result from a hiatal hernia.
If a CT scan has already identified a hiatal hernia, ask the clinician who ordered the scan whether the finding needs further investigation. The answer depends on the details of the report, any associated symptoms, and the purpose of the original examination.