Achalasia with aspiration
Young man. Ex-smoker. 3 year history of cough and increasing shortness of breath.
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Grossly dilated oesophagus down to the GOJ with air-fluid level.
Multifocal, ill-defined peribronchial consolidations in both lungs, most pronounced in the upper lobes.
Focal cystic bronchiectasis involving the anterior segment of the right upper lobe.
No evidence of interstitial fibrosis.
This patient presented without swallowing complaints. He had respiratory symptoms.
His symptoms relate to the sequalea of the achalasia - recurrent aspiration into his lungs. This is one of the recognised associated issues with this condition.
One can appreciate from the appearance of the oesophagus on the CT how prone the patient would be to chronic aspiration pneumonia.