Diagnostics Images

Dr. A. Nagarajan*

Department of Pulmonology, Kauvery Hospital, Cantonment, Trichy

*Correspondence: Email: [email protected]

IMAGE CHALLENGE

History

A 65 years old man presented with complaints of fever, and cough with sputum for the past 2 weeks.

Associated illnesses

He also had symptoms of dysphagia, burning chest pain, and belching sensation, along with a history of weight loss

Investigation

  1. He underwent routine blood examinations
  2. X-ray Chest PA view showed left lower lobe basal segmental consolidation suggestive of the possibility of aspiration. He was started on empirical antibiotics pending sputum microbiology. He was further evaluated for dysphagia.

imge-challenge

 

What is your diagnosis?

Answer

Contrast-enhanced X-ray with barium swallow showed dilated esophagus with tapering at the lower esophageal junction giving a bird beak-like appearance, consistent with the diagnosis of Achalasia cardia.

Notes

  1. Achalasia cardia is a rare disorder characterized by inflammation and degradation of the myenteric plexus leading to loss of oesophageal sphincter and oesophageal peristalsis.
  2. Treatment options include Pneumatic dilatation, Per-Oral Endoscopic Myomotomy (POEM), Heller’s myomotomy.

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