Chronic achalasia

Case contributed by Dr Catriona Reid
Diagnosis almost certain


Weight loss, weakness and cough.

Patient Data

Age: 85 years
Gender: Female

Chest radiograph demonstrated a widened mediastinum with a mottled tubular structure demonstrated superiorly at the sternoclavicular joint extending down to the diaphragm.


CT chest/abdomen/pelvis demonstrated gross distension of the entire esophagus with food debris.


Barium swallow corroborated these findings and also demonstrated a narrowed distal esophagus.

Case Discussion

The diagnosis of achalasia was confirmed on esophagogastroduodenoscopy (EGD). The case provides an example of how achalasia can present on chest radiographs and highlights a differential for a widened mediastinum.

Case submitted by Dr Catriona Reid and Dr Alaa Ismail.

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