Hiatal hernia: the "X" factor in transesophageal echocardiography.

Two patients with large hiatal hernias underwent transesophageal echocardiographic examinations. In one case adequate images could not be obtained. In the other, skewed images and misleading information required other modes of investigation. We propose that the presence of a large hiatal hernia may lead to poor images or total inability to collect sonographic data.