Case contributed by Frank Gaillard


Grave difficulties swallowing both food and liquids.

Patient Data

Age: 20 years
Gender: Female

Dilated esophagus with smooth distal tapering giving the bird beak appearance quite characteristic of achalasia

Case Discussion

Achalasia is an esophageal motility disorder due to a failure of relaxation of the lower esophageal sphincter. This occurs due to an abnormality within the Auerbach plexus - be it primary or secondary.

Barium swallow demonstrates:

  1. beaked tapering of the esophagus at the gastro-esophageal junction
  2. a grossly dilated esophagus
  3. tertiary contractions
  4. air-fluid level on the control/plain film

Key Points:

  1. achalasia is associated with an increased risk of esophageal malignancy
  2. beware of pseudoachalasia due to the destruction of the plexus by a tumor such as linitis plastica
  3. the radiologist has a role in treatment by balloon dilatation

Image courtesy of Dr Ian Bickle

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