Achalasia

Case contributed by Dr Hani Salam

Presentation

Dysphagia and recurrent chest infection.

Patient Data

Age: 40 years
Gender: Male
X-ray

Chest x-ray

Chest x-ray is largely unremarkable. Minor patchy opacities in the left base are noted. A small gastric air bubble is visible.

Fluoroscopy

Barium swallow

Upper GI study reveals uniform dilatation of the esophagus to the level of the gastroesophageal junction, where fixed narrowing is noted (bird peak sign or rat-tail sign). Repeated observation by flouroscopy confirmed failure of relaxation of the lower esophageal sphincter and prolonged retention of barium in the esophagus. 

CT

CT chest / abdomen / pelvis

CT scan of the abdomen showed uniform dilatation of esophagus with air-fluid level. Pulmonary infiltrates in the upper segment of the right lower lobe likely due to aspiration.

Case Discussion

This case illustrates typical features of achalasia, complicated by aspiration pneumonitis, as relatively common complication.

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Case information

rID: 8831
Case created: 2nd Mar 2010
Last edited: 26th Jul 2017
Inclusion in quiz mode: Included

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