Achalasia

Case contributed by Assoc Prof Frank Gaillard

Presentation

Grave difficulties swallowing both food and liquids.

Patient Data

Age: 20 years
Gender: Female
Barium

Dilated esophagus with smooth distal tapering giving the bird beak appearance quite characteristic of achalasia

Case Discussion

Achalasia is an esophageal motility disorder due to a failure of relaxation of the lower esophageal sphincter. This occurs due to an abnormality within the Auerbach plexus - be it primary or secondary.

Barium swallow demonstrates:

  1. beaked tapering of the esophagus at the gastro-esophageal junction
  2. a grossly dilated esophagus
  3. tertiary contractions
  4. air-fluid level on the control/plain film

Key Points:

  1. achalasia is associated with an increased risk of esophageal malignancy
  2. beware of pseudoachalasia due to the destruction of the plexus by a tumor such as linitis plastica
  3. the radiologist has a role in treatment by balloon dilatation

Image courtesy of Dr Ian Bickle

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.