Paraesophageal hernia secondary to failed Nissen fundoplication mimicking lung abcess.

A 9 1/2-month-old girl was transferred to our institution for evaluation and treatment of a lung abscess. Presenting symptoms included low-grade fever, irritability, diarrhea, and tachypnea. Chest radiograph showed a dense opacity with an air-fluid level in the lower portion of the right hemithorax. When the radiograph was reviewed carefully, surgical clips from a previous Nissen fundoplication were visible within the area of consolidation. A barium study revealed evidence of a large paraesophageal hernia with an air fluid level, and no evidence of a lung abscess. The patient had a laparoscopic revision of the Nissen, which had slipped superiorly, and an esophageal hernia repair. Postoperatively, the patient did well and was discharged without any complications.