Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review

Figure 5 A 78-year-old woman with esophageal hiatal hernia. A: Compared to the gray-scale imaging (right panel), contrast-enhanced ultrasound imaging clearly showed the esophageal hiatus (large arrows), the supradiaphragmatic hernial sac (HS), and esophagus-gastric echo ring (i.e., the “EG” ring) (small arrows); B: Ultrasound image obtained with conventional oral contrast agent showed the HS; C: Gastroscopic front view showed the dentate line to be shifted upwards and separated from the gastroesophageal junction; D: In the reverse view, the cardia opening was shown to be loosened and the double ring sign was partially visible; E: High-resolution esophageal pressure measurement showed type III esophageal hiatal hernia. HS: Hernial sac; ST: Stomach.