Paraesophageal hernias are relatively rare compared to the more commonly diagnosed sliding hiatus hernia. They tend to be asymptomatic initially, but may gradually enlarge and present with life-threatening complications. The treatment is surgical reduction, preferably as an elective procedure. Computed tomography (CT) clearly demonstrates a paraesophageal hernia through a widened esophageal hiatus, often as an incidental finding, and accurately documents the size, contents, and orientation of the herniated stomach within the lower thoracic cavity. In this report, the CT appearance of 4 patients with paraesophageal hernias is described along with a discussion of this uncommon but important surgical condition.