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Clinical Problem Solving: Radiology
February 2007

Radiology Quiz Case 2: Diagnosis

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2007;133(2):197. doi:10.1001/archotol.133.2.197

A grossly dilated cervical esophagus giving rise to a palpable neck mass and upper airway compression with stridor is an extremely unusual presentation of achalasia.1,2 In this case, chest (Figure 1) and neck (Figure 2) radiographs showed a hugely dilated, air-filled cervical esophagus that was causing anterior displacement of the cartilaginous framework of the larynx and projection over the right superior mediastinum. Although the patient's symptoms resolved spontaneously, her medical condition was complicated by new-onset atrial fibrillation, and it was thought not to be in her best interests to proceed with further invasive investigation. Information was gathered from a previous admission to another hospital, where direct esophagoscopy and laryngoscopy had shown a tortuous, dilated esophagus, and those findings, along with the results of a barium swallow, had led to a diagnosis of achalasia.

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