Case contributed by Hani Makky Al Salam


Dysphagia and recurrent chest infection.

Patient Data

Age: 40 years
Gender: Male

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.

Barium swallow


Upper GI study reveals uniform dilatation of the esophagus to the level of the gastro-esophageal junction, where fixed narrowing is noted (bird beak sign or rat-tail sign). Repeated observation by fluoroscopy confirmed failure of relaxation of the lower esophageal sphincter and prolonged retention of barium in the esophagus. 

CT chest / abdomen / pelvis


CT scan of the abdomen showed uniform dilatation of the esophagus 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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