PREVALENCE AND CLINICAL IMPLICATIONS OF INCIDENTALLY DETECTED HIATAL HERNIA ON CHEST COMPUTED TOMOGRAPHY

Kristina Dimitrijevikj

Kristina Dimitrijevikj University Clinic of Pulmonolgy and Allergology, Faculty of Medicine, Ss. Cyril and Methodious in Skopje, North Macedonia

Abstract

Abstract

Background: Hiatal hernia is a common but often underrecognized condition, and although computed tomography (CT) enables reliable detection, data on CT-based prevalence and diagnostic agreement remain limited. Aim: To determine the CT-based prevalence of hiatal hernia, describe demographic characteristics, hernia size distribution and associated symptoms, and assess interobserver agreement. Materials and Methods: This retrospective study analyzed 1045 chest CT examinations performed over a 6-month period from August to January 2026 at the University Clinic of Pulmonology and Allergology, Skopje, using a PHILIPS INCISIVE 128 slice scanner optimized for thoracic imaging. Hiatal hernia prevalence was calculated based on CT findings. Demographic data, hernia size and associated symptoms were analyzed in patients with hiatal hernia. Interobserver agreement was evaluated in a randomly selected subset of 267 CT examinations independently reviewed by two radiologists using Cohen kappa with 95% confidence intervals.

Results: Hiatal hernia was identified in 119 of 1045 CT examinations, yielding a prevalence of 11.4%. The mean age of affected patients was 66.3 years, range 31-84 years, with female predominance (73.1%). Small hiatal hernias were most frequent (81.5%), followed by medium (11.8%) and large (6.7%) hernias. Chronic obstructive pulmonary disease was present in 21.0% of patients. Interobserver agreement for CT detection of hiatal hernia was substantial, kappa 0.74, 95% confidence interval 0.59-0.90.

Conclusion: Hiatal hernia is a relatively common incidental finding on chest CT, predominantly affecting older female patients, with small hernias being most frequent, while CT demonstrates substantial interobserver agreement, supporting its reliability in detection.

Keywords: hiatal hernia, HRCT, incidental chest findings

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