Case contributed by Dr Ian Bickle


Progressive swallowing difficulties, more so to solids.

Patient Data

Age: 40 years
Gender: Male

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

Bird beak appearance at the GEJ. 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 esophagus on control film
  2. a distended esophagus with an air-fluid level
  3. an adynamic esophagus
  4. a distal acute taper of the esophagus with a bird-beak appearance.

The bird-beak sign is used to refer to the tapering of the inferior esophagus 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: 5th Oct 2020
Inclusion in quiz mode: Included

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