Presentation
Dysphagia for both solids and liquids.
Patient Data
Chest x-ray demonstrates a convex opacity overlapping the right mediastinum which may be due to dilated oesophagus filled with retained secretions and food. Small gastric bubble with aerated splenic flexure. Both lungs are clear. No pleural effusion is seen.
On barium swallow, the oesophagus is dilated, filled with food residue with acute tapering at the lower oesophageal sphincter, producing a "bird's beak" appearance.
Case Discussion
Features are most consistent with achalasia (or primary achalasia) which is a failure of organised oesophageal peristalsis causing impaired relaxation of the lower oesophageal sphincter with often marked dilatation of the oesophagus and retained secretions and food.
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