 Hello, everyone. This is Dr. Surajuval Keshav Jaiswal, first year radio diagnosis junior resident in Dr. D. Y. Patil Hospital Colapur. I would like to thank Indian radiologist for allowing me to present this paper in the conference of city bus. My topic is hiatus hernia and gastric volvulus imaging. This is the paper presentation. I would like to thank my mentor, Dr. Pradeep Patil, who is professor in department of radio diagnosis in D. Y. Patil Hospital Colapur, aims and objectives. The aim is to study the multimodality imaging features of hiatus hernia and gastric volvulus association. The objective is to learn the various imaging features in hiatus hernia and gastric volvulus cases. So the introduction and background, hiatus hernia is a condition in which upper part of stomach or other internal organ bulges through the hiatus of the diaphragm. When there is laxity in this hiatus, gastric content can back up into the esophagus and it is the leading cause of gastroesophageal reflux disease. In hiatus hernia, the stomach pushes through the opening in the diaphragm, hiatus and into the chest and compromises the lower esophageal sphincter. This laxity of the lower esophageal sphincter can allow gastric content and acid to back up into the esophagus and this is the leading cause of gastroesophageal reflux disease. While a small hiatus hernia is often symptomatic and can typically be managed medically, large hiatus hernias often require surgery. Approximately 55 to 60% of individuals above the age of 50 have hiatus hernia. However, only 9% have symptoms and it depends on the type and competency of the lower esophageal sphincter. The vast majority of these hernias are type 1 sliding hiatus hernias. Type 2 parisophageal hernias only make up about 5% of hiatal hernias where the lower esophageal sphincter remains stationary but the stomach protrudes above the diaphragm. Classification type 1 is the sliding type which represents more than 95% of the cases occurs when the G-junction is displaced upwards through the hiatus. Type 2 is the parisophageal hiatus hernia which occurs when part of stomach migrates into the midiastinum parallel to the esophagus. Type 3 is when both the parisophageal and sliding hernias are involved where both the G-junction and part of the stomach have migrated into the midiastinum. Type 4 is when the stomach as well as an additional organ such as the colon small intestine or spleen also herniate into the chest. The gastric volvulus is a specific type of volvulus that occurs when the stomach twists on its mesentery. It should be at least 180 degrees and cause bowel obstruction to be called gastric volvulus. Epidemology organoexial volvulus is more common in adults responsible for 60% of presentations. Mesenteroexial volvulus is more common in children. Clinical presentation Borscha triad is classic and it includes the intractable reaching without vomiting, inability to pass an esogastric tube and sudden severe epigastric pain. So this image shows the two types of the volvulus. When the stomach twists around the long axis it is known as the organoexial type and when it twists around the short axis it is the mesenteroexial in which the pylorus goes above the level of the G-junction. So the organoexial volvulus it occurs when the stomach rotates along its long axis and becomes obstructed with a greater curvature being displaced superiorly and the lesser curvature located more cowardly in the abdomen. Entrum rotates enteros superiorly and the fundus rotates posteriorly. The mesenteroexial volvulus occurs when the stomach rotates along its short axis with the resultant displacement of entrum above the G-junction. Rotation is usually partial and is not associated with a diaphragmatic defect. Twist greater than 180 degrees in an organoexial and if a positive oral contrast is administered it is retained in the stomach. In mesenteroexial the stomach it is not retained in the stomach if a positive oral contrast is used. Organoexial is more common type and the mesenteroexial is less common but is more common in the pediatric population. Methods and materials. Few of the suspected or incidentally diagnosed hiatus hernia cases and gastric volvulus association on various imaging modalities which include plane radiograph, barium study, ultrasonography and computer tomography in the department of radio diagnosis, Dr. Debye Patil Medical College Hospital and Research Institute, Kolhapur included in the study. Case one is a 70 year old female presented to the ophthalmology department with clouding of vision. She had no other complaints. She was diagnosed to have cataract before posting the patient for surgery. A chest radiograph was taken for surgical fitness and the plane radiograph shows a retrocardiac capacity with gas fluid level in the PA and the lateral views. Single contrast barium swallow was done in this case which shows upward displacement of the gastroesophageal junction through the hiatal opening in the diaphragm which suggests sliding hiatal hernia type one. Next case is a 24 year old male who came with the complaint of vomiting and epigastric pain since five days. No other complaint was there. Plain chest CT was done including the abdomen. It shows the gastric distention with rotation around the short axis from lesser to the greater curvature and herniation through the hiatus indicating an obstruction. G-junction is shifted above the level of the diaphragm as we can see in these images. Suggestive of mixed type of hernia in which G-junction and part of stomach is herniated. Case three a 34 year old male came with a history of road traffic accident complaining of chest pain. He also had a neck femoral neck fracture on the left side. Plain radiograph and an ultrasound in this case shows a gastric shadow in the lower lung zone. Suggestive of herniation. On further scan a plain chest CT scan was done and we can see the gastric rotation around the short axis with herniation through the hiatus and a bilateral pulmonary effusion is seen. The gastroesophageal junction is seen below the level of the diaphragm suggesting a parisophageal type of hernia which is type two where only the gastric content is herniated and the G-junction is below the diaphragm. Next case a 77 year old male presented with the complaints of epigastric pain. Contrast CT was done. Now we can see the gastric distinction with the rotation around the short axis again from lesser to the greater curvature and herniation through the hiatus can be seen. Pylorus can be seen above the level of the diaphragm and G-junction is seen below the level of the diaphragm. It is suggestive of a parisophageal type of hernia in which only the gastric contents are herniating through the defect. So the conclusion this study underscore the importance of various imaging modalities in the diagnosis of herniated hernia along with the associated gastric vulvulus and shows various imaging features in this cases in the modality modality imaging. These are the references. Thank you.