Clinical Practice and Cases in Emergency Medicine (Nov 2019)

An Elderly Woman With Gibbus Deformity and Physiologic Shock

  • Shuntaro Sakai,
  • Yoji Hirayama,
  • Motoji Oki

DOI
https://doi.org/10.5811/cpcem.2019.6.42522
Journal volume & issue
Vol. 3, no. 4

Abstract

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Physiological shock requires prompt diagnosis and treatment in the emergency department. We present a case of physiological shock in a 91-year-old woman resulting from obstruction of the left atrium and inferior vena cava by a giant esophageal hiatal hernia, identified using computed tomography imaging. The patient’s age and history, including diet and eating behavior (namely needing to lie down immediately after a meal), and kyphotic posture were important factors to consider in establishing the differential diagnosis. While rare, a giant esophageal hiatal hernia should be considered in the differential diagnosis of obstructive shock.