Achalasia - pediatric
Dysphagia for both solids and liquids.
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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 beak" appearance.
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.