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 oesophagus to the level of the gastro-oesophageal junction, where fixed narrowing is noted (bird beak sign or rat-tail sign). Repeated observation by fluoroscopy confirmed failure of relaxation of the lower oesophageal sphincter and prolonged retention of barium in the oesophagus. 

CT

CT chest / abdomen / pelvis

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

Case Discussion

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

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Case information

rID: 8831
Published: 2nd Mar 2010
Last edited: 5th Apr 2018
Inclusion in quiz mode: Included

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