Case of the Week - Patient Summary 6630Peer Reviewed and Certified -
Achalasia Balloon Dilatation
Heller myotomy
Radiographic findings on barium examinations include conical smooth narrowing of the distal esophagus in a “bird-beak” or “rat-tail” configuration with most pronounced narrowing at the gastroesophageal junction as this case demonstrates. Breakup of the primary stripping wave is noted below the level of the cricopharyngeus muscle and there is proximal dilatation of the esophagus. A food/debris level can be noted as ingested material is often retained within the esophagus which the patient may be unaware of which can even be a chest radiograph finding. When early achalasia is suspected the examination should also be performed in a recumbent position so that the effects of gravity are removed (which could potentially mask the disease).
Achalasia may be primary in which the cause is idiopathic or secondary in which there is carcinomatous invasion of the myenteric plexus or even infectious (Chaga’s disease). Endoscopy is frequently required to make a visual and pathologic diagnosis (biopsy).
