Case contributed by Jan Frank Gerstenmaier


Dysphagia and chest pains. He has never been to South America.

Patient Data

Age: 45 years
Gender: Male

The gastric gas bubble is absent. Lungs appear normal. Heart and mediastinal contours appear normal.


Single and double contrast barium swallow show markedly delayed emptying of the esophagus and smooth tapering of the distal esophagus, compatible with failure of sphincter to relax.


The esophagus is dilated and distally there is smooth circumferential wall thickening. Fluid-fluid level is present in the esophagus. There is no evidence of aspiration at this time. No lymphadenopathy.

Case Discussion

The thick-walled esophagus was biopsied and there was no evidence of malignancy. As in most patients with achalasia, this case was idiopathic.

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