Diaphragmatic hernia mimicking an atrial mass: a two-dimensional echocardiographic pitfall and a cause of postprandial syncope.

A large hiatal hernia constitutes a form of posterior mediastinal mass that can encroach on the posterior aspects of the heart. During two-dimensional echocardiography this phenomenon may be confused with an intra-atrial mass or various other posterior mediastinal masses. Furthermore, such a large hiatal hernia encroaching on the heart may cause syncope. We present such a case and the various possible mechanisms of syncope, as well as review the two-dimensional echocardiographic pitfalls in these patients.