Severe oesophageal dilatation causing airway compromise

Case contributed by Dr Joe Mullineux

Presentation

Breathlessness and stridor.

Patient Data

Age: 55-60Y
Gender: Female

CXR

Modality: X-ray

Frontal chest radiograph shows a large lobulated mass overlying the medial right upper lung zone, which appears to be arising from the mediastinum. The mass has heterogenous density superiorly. There are further smooth lobulated masses projected over the mediastinum behind the heart. The trachea does not appear deviated.

CT Chest

Modality: CT

The oesophagus is massively dilated and filled with food debris. It is compressing the upper trachea and displacing the carina and left atrium anteriorly. There is no obstructing oesophageal mass or wall thickening. The stomach is collapsed. No evidence of aspiration or consolidation in the lungs.

CT of the chest confirms upper airway compression from a dilated oesophagus. The distal narrowing suggests achalasia.

Case Discussion

The CT shows a massively dilated and debris-filled oesophagus resulting upper airway obstruction, explaining the mediastinal mass demonstrated on CXR and clinical presentation. The point of esophageal narrowing is in the distal esophagus and the combination of findings suggests achalasia.

Urgent decompression of the oesophagus was advised.

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Case Information

rID: 46326
Case created: 30th Jun 2016
Last edited: 11th Sep 2016
Inclusion in quiz mode: Included

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