Case contributed by Derek Smith
Diagnosis certain


Admitted with shortness of breath. Previously investigated for ?dysphagia. Few bibasal crackles on auscultation. ?pneumonia ?fluid overload

Patient Data

Age: 60 years
Gender: Male

Distended esophagus with gas/fluid level at the level of the carina.

Chronic left basal changes. No focal consolidation or lobar collapse.

Normal heart size with normal pulmonary vascularity. Pleural spaces clear.

Previous barium swallow


Double-contast study:

Distended atonic esophagus with relaxed lower esophageal sphincter.

No mass or stricture.

Case Discussion

This patient had advanced achalasia which was an incidental finding on the admission CXR.

No features of aspiration which these patients are at higher risk of.

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