Surgical repair of paraesophageal hernias, even when a large portion of the stomach has herniated intrathoracically, is now feasible using lap-aroscopic techniques. Repair is possible with a low morbidity rate and good results, prompting some surgeons to advocate corrective surgery electively in patients who present with an intrathoracic stomach. Pre-operative imaging studies, which elucidate the abnormal anatomy, can be of considerable help in planning the surgery. Radiologists thus need to be familiar with the anatomy and complications of a paraesophageal hernia. Current textbooks of gastrointestinal radiology cover this topic with little detail, and to our knowledge, this subject has not been addressed in recent publications in the radiology literature [1-3].