Presentation
Breathlessness and stridor.
Patient Data
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.
The esophagus 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 esophageal 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 esophagus. The distal narrowing suggests achalasia.
Case Discussion
The CT shows a massively dilated and debris-filled esophagus 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 esophagus was advised.