A 14-year-old girl was referred to the outpatient clinic by her general practitioner, complaining of intermittent wheezing, coughing, and expectoration of yellow-brown sputum. At the age of 8 years, she had been examined in the pediatric department for back pain. On that occasion, she complained of severe central back pain about one minute after eating bulky foods. The pain was described as sharp and of sufficient intensity to make her cry. Investigations at that time, including full blood count, ESR, chest roentgenogram, and barium meal, were interpreted as normal. On physical examination, the patient was a normally developed 14-year-old who looked well. There were no abnormal physical findings.Figures 1 and 2 were obtained at the time of the present clinic admission.
Achalasia of the esophagus.
Posteroanterior and lateral chest films demonstrate a right paramediastinal mass extending from the right hemidiaphragm into the superior mediastinum. On the
Mills JW. Respiratory Symptoms With Normal Physical Findings. JAMA. 1977;237(24):2637–2638. doi:10.1001/jama.1977.03270510059030