Presentation
Dysphagia for solids for 9 months.
Patient Data
CT chest, abdomen with Oral and IV contrast:
Gross distension of the entire esophagus down to be the gastroesophageal junction, consistent with achalasia.
No obvious evidence of complicating esophageal carcinoma. No mediastinal lymphadenopathy.
Lung fields are unremarkable with no evidence of chronic aspiration.
In the abdomen the appearances are unremarkable.
Case Discussion
The case shows typical achalasia of the cardia with esophageal dilatation and tortuosity due to the failure of relaxation of the lower esophageal sphincter possibly due to degeneration of myenteric Auerbach's Plexus. The main differential diagnosis is 2ry achalasia due to lower esophageal or gastroesophageal carcinoma (pseudoachalasia).
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