Achalasia - pediatric

Case contributed by Dr Ammar Haouimi

Presentation

Dysphagia for both solids and liquids.

Patient Data

Age: 10 years
Gender: Female
Barium

Chest x-ray demonstrates a convex opacity overlapping the right mediastinum which may be due to dilated esophagus 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 esophagus is dilated, filled with food residue with acute tapering at the lower esophageal sphincter, producing a "bird's beakappearance.

Case Discussion

Features are most consistent with achalasia (or primary achalasia) which is a failure of organized esophageal peristalsis causing impaired relaxation of the lower esophageal sphincter with often marked dilatation of the esophagus and retained secretions and food.

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