Introduction: Proximal displacement of stomach and gastro-esophageal junction into the thoracic cavity results in a condition known as hiatal hernia (HH). Sometimes this entity is neglected in practice and the patient is handled as gastroesophageal reflux disease, asthma or other non-surgical diagnosis.
Case: Here we present a 6 months-old female infant who present with bloody emesis since two months of age. She evaluated and labeled as gastritis and managed with proton pump inhibitors. Finally, after developing respiratory complaints, a strange retro cardiac shadow help physicians in reaching the correct diagnosis.
Discussion: In primary work up of patents with gastrointestinal or respiratory complaints we should consider some anatomical abnormalities that can easily be missed. HH is one of these neglected entities especially in pediatric population.