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{
    "pk": 713,
    "title": "An Elderly Woman With Gibbus Deformity and Physiologic Shock",
    "subtitle": null,
    "abstract": "Physiological shock requires prompt diagnosis and treatment in the emergency department. We present a case of physiological shock in a 91-year-old woman resulting from obstruction of the left atrium and inferior vena cava by a giant esophageal hiatal hernia, identified using computed tomography imaging. The patient’s age and history, including diet and eating behavior (namely needing to lie down immediately after a meal), and kyphotic posture were important factors to consider in establishing the differential diagnosis. While rare, a giant esophageal hiatal hernia should be considered in the differential diagnosis of obstructive shock.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Images in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3zp4r0hx",
    "frozenauthors": [
        {
            "first_name": "Shuntaro",
            "middle_name": "",
            "last_name": "Sakai",
            "name_suffix": "",
            "institution": "Mutsu General Hospital, Department of Cardiology, Mutsu City, Aomori",
            "department": "None"
        },
        {
            "first_name": "Yoji",
            "middle_name": "",
            "last_name": "Hirayama",
            "name_suffix": "",
            "institution": "Hashimoto Municipal Hospital, Department of General Internal Medicine, Hashimoto, Wakayama",
            "department": "None"
        },
        {
            "first_name": "Motoji",
            "middle_name": "",
            "last_name": "Oki",
            "name_suffix": "",
            "institution": "Hachinohe City Hospital, Department of Gastroenterology, Endoscope, and Chemotherapy, Hachinohe, Aomori",
            "department": "None"
        }
    ],
    "date_submitted": "2019-08-14T16:25:19-07:00",
    "date_accepted": "2019-08-14T16:25:19-07:00",
    "date_published": "2019-08-14T16:27:23-07:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/713/galley/469/download/"
        }
    ]
}