A thrilling case of hiatus hernia.

A 65 year old woman was found to have a left parasternal heave and a systolic murmur associated with a thrill. A chest radiograph, echocardiogram and gastrograffin swallow demonstrated a massive obstructed hiatus hernia which displaced the heart anteriorly. Aspiration of the contents of the hernia led to complete resolution of the physical signs. Possible mechanisms for their production are discussed.