Barium swallow of a large paraesophageal hernia

Barium swallow of a paraesophageal hernia. Note that as the herniated stomach enlarges, it inverts and twists causing a volvulus. In the extreme, this results in an upside-down stomach. The esophagus is not seen in this image, but if the gastroesophageal junction is at the level of the diaphragm, this would be a type II (paraesophageal) hernia. More commonly, it is above the diaphragm, which makes it a type III (paraesophageal) hernia.