What is the most likely diagnosis and what are the differentials?
Diagnosis: achalasia. Differential diagnosis: Oesophageal dilatation from progressive systemic sclerosis. Oesophageal dilatation from acquired focal obstruction: carcinoma, metastasis, non-neoplastic stenosis.
What are the causes of this condition?
1. Primary or idiopathic in most of the cases, related to ganglion cell deficiency in the oesophageal myenteric smooth muscle plexus. 2. Secondary achalasia (a.k.a. pseudoachalasia) resulting from Chagas disease or from malignancy at the gastro-oesophageal junction.
What are the findings that suggest a secondary cause?
Eccentricity, modularity, angulation, straightening, and proximal shouldering of the narrowed oesophageal segment and a length of narrowing greater than 3.5 cm on barium swallow study suggests secondary achalasia and malignancy must be excluded.
Heterogenous and dependent contents seen in a dilated oesophagus that produce mass effect on the heart and tracheobronchial tree.