Chronic achalasia
Presentation
Weight loss, weakness and cough.
Patient Data
Age: 85 years
Gender: Female
From the case:
Chronic achalasia
X-ray
Frontal
Chest radiograph demonstrated a widened mediastinum with a mottled tubular structure demonstrated superiorly at the sternoclavicular joint extending down to the diaphragm.
From the case:
Chronic achalasia
CT
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Coronal C+ arterial phase
CT chest/abdomen/pelvis demonstrated gross distension of the entire esophagus with food debris.
From the case:
Chronic achalasia
Barium
Oblique
Barium swallow corroborated these findings and also demonstrated a narrowed distal esophagus.
Case Discussion
The diagnosis of achalasia was confirmed on esophagogastroduodenoscopy (OGD). 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.