Achalasia

Case contributed by Dr Ian Bickle

Presentation

Progressive swallowing difficulties, more so to solids.

Patient Data

Age: 41
Gender: Male
Modality: Barium

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
Case created: 27th Feb 2016
Last edited: 14th Aug 2016
Inclusion in quiz mode: Included

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