This is the case of a 78-year-old woman with a 2-h history of intense oppressive chest pain associated with sweating and poor general condition. The examination of the patient’s heartbeats reveals a visible and overt vibration at thoracic wall level. The bedside echocardiography performed in the parasternal view—both in the long (figure 1) and short axes (figure 2)—revealed the presence of extrinsic compression of the heart by a fluid-and-air-filled heart chamber (in blue color) that caused the protrusion of the heart lower side (in green color). The CCTA performed discards the presence of acute aortic disease but confirms the presence of massive hiatal hernia with complete herniation of the gastric chamber (figure 3) (Fig. 1).

Figure 1

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