Objective To improve the clinical understanding of Esophageal hiatal hernia (EHH) and to investigate its diagnostic value with spiral CT scan. Methods The CT imaging characteristics of 20 patients with EHH from Jul.2013 to Apr.2015 were analyzed which were diagnosed by upper gastrointestinal barium examination or gastroscopy. Results The hernia sac of 18 cases is in the front-left of descending aorta and spine and 7 cases locate in the front or on the right side of the spine. Among them, the hernia sac and "gastric mucosa in chest" of 20 cases were clearly demonstrated on CT images. The herniation of gastric body of 14 cases has a corset - like change. Morphology of hernia sac presents "Cable sign" in 2 cases. 6 cases with Oral contrast agents and 8 cases with CT enhanced scan of CT images show that gastric mucosathrough esophageal hiatusand homogeneous enhancement was detected in the hernia sac wall and the gastric wall after contrast administration. 3 cases of EHH were associated with greater omentuml via esophageal hiatus. The distance between thecrura of diaphragm was widened in 13 cases of EHH. Conclusions The atypical and non-specific symptoms of EHH result in high misdiagnosis rate. CT MPR can clearly display many characteristic signs of EHH. CT is helpful for the differential diagnosis of EHH, providing an important supplementary examination for patients with intolerance of upper gastrointestinal barium examination or gastroscopy.