Case contributed by Dr Ian Bickle


Progressive swallowing difficulties, more so to solids.

Patient Data

Age: 41
Gender: Male

Dilated, adynamic oesophagus with a fluid level and failure to empty.

Bird beak appearance at the GOJ. Trace of barium into the stomach.

Case Discussion

The appearances of achalasia are almost pathognomonic on barium swallow.  These include:

1.  A gas filled dilated oesophagus on control film

2.  A distended oesophagus with an air-fluid level

3.  An adynamic oesophagus

4. A distal acute taper of the oesophagus with a bird-beak appearance.

The bird-beak sign is used to refer to the tapering of the inferior oesophagus in achalasia.   This has a smooth outline implying a non-malignant cause.    A rat's tail appearance is used interchangeably.

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Case information

rID: 43183
Published: 27th Feb 2016
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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