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Primary Achalasia

Story SGS - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Primary Achalasia

History: The patient is a 56 yo male with a 1.5yr history of globus sensation and dysphagia. He feels like it has been getting progressively worse over past few months. He reports difficulty swallowing both liquids as well as solids and states that it feels like it is getting caught up high in his throat. The patient denies recent weight loss or associated pain with swallowing. He reports a greater than 10 year history of GERD and has a remote 20 pack-year smoking history.

Findings: The swallowing mechanism is intact. The vocal cords moved appropriately with phonation. There was no visualized nasopharyngeal reflux or aspiration. Proximal esophageal dilation measured to be 4.5cm at greatest dimension. Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm. Distal esophagus showed evidence of sigmoidization. Constellation of findings most consistent with achalasia.

Ddx: Esophageal web/ring, esophageal stricture, malignancy (esophageal SCC, adenocarcinoma), achalasia, scleroderma, diffuse esophageal spasm, neuromuscular disorder, esophageal diverticuli

Dxhow: Based on upper endoscopy and barium swallow

Exam: Physical exam was unremarkable

No MeSH data available.


Proximal esophageal dilation measured to be 4.5cm at greatest dimension.  Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm.   Distal esophagus showed evidence of sigmoidization.
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MPX1083_synpic58432: Proximal esophageal dilation measured to be 4.5cm at greatest dimension. Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm. Distal esophagus showed evidence of sigmoidization.


Primary Achalasia

Story SGS - MedPix

Proximal esophageal dilation measured to be 4.5cm at greatest dimension.  Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm.   Distal esophagus showed evidence of sigmoidization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1083&req=5

MPX1083_synpic58432: Proximal esophageal dilation measured to be 4.5cm at greatest dimension. Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm. Distal esophagus showed evidence of sigmoidization.

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Primary Achalasia

History: The patient is a 56 yo male with a 1.5yr history of globus sensation and dysphagia. He feels like it has been getting progressively worse over past few months. He reports difficulty swallowing both liquids as well as solids and states that it feels like it is getting caught up high in his throat. The patient denies recent weight loss or associated pain with swallowing. He reports a greater than 10 year history of GERD and has a remote 20 pack-year smoking history.

Findings: The swallowing mechanism is intact. The vocal cords moved appropriately with phonation. There was no visualized nasopharyngeal reflux or aspiration. Proximal esophageal dilation measured to be 4.5cm at greatest dimension. Narrowing of short segment of the lower esophageal sphincter length measured to be 1.25cm. Distal esophagus showed evidence of sigmoidization. Constellation of findings most consistent with achalasia.

Ddx: Esophageal web/ring, esophageal stricture, malignancy (esophageal SCC, adenocarcinoma), achalasia, scleroderma, diffuse esophageal spasm, neuromuscular disorder, esophageal diverticuli

Dxhow: Based on upper endoscopy and barium swallow

Exam: Physical exam was unremarkable

No MeSH data available.