AP image from an esophagram shows a dilated esophagus with f | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

AP image from an esophagram shows a dilated esophagus with flocculated contrast in the lower esophagus and a tight stenosis, typical of achalasia at the gastroesophageal junction. Achalasia is a neurologic disorder of esophageal motility caused by a loss of ganglion cells at the gastroesophageal junction leading to a lack of esophageal relaxation and creation of a functional distal esophageal stricture. When the narrowing is severe, food and liquid are retained in the esophagus causing an air-fluid level. Other entities that can cause a mediastinal air-fluid level include colonic interposition and abscess. #FridayQuizDay #Quiz #FridayQuiz

Why you should join Figure 1

Similar cases



esophageal stent removed s/p esophageal cancer stricture. #Endoscopy #Esophagus #Gastroesophageal-reflux-disease #Gastroenterology #BarettsEsophagus](https://app.figure1.com/case-detail/10251636-6bdd-485b-a63d-32c94fe35ad9)



Esophagram in an adolescent with recurrent emesis and achalasia shows narrowing of the distal esophagus just proximal to the gastroesophageal junction. There is a mild "birds beak" appearance (arrow) of the esophagus at this level. Achalasia is an esophageal motility disorder caused by dysfunction of the mesenteric plexus leading to fix contraction of the lower esophageal sphincter. #ThoraxThursday #ThoracicThursday](https://app.figure1.com/case-detail/449160e2-4d51-454c-bf17-d735d1608d8e)



Frontal chest radiograph (image 1) shows a dilated air-filled esophagus (arrow). Upper GI images (images 2 and 3) show a bird's beak appearance of the distal esophagus (arrowhead) with dilation of the proximal esophagus (arrow). Irregular contractions and esophageal dysmotility are present. Achalasia is thought to be caused by a neuropathy of Auerbach's plexus. This causes the lower esophageal sphincter to remain contracted. Patient presents with dysphagia and halitosis.](https://app.figure1.com/case-detail/517419cf-e0c7-4f7c-b592-8343793bc6fe)



Markedly distended, air-filled and tortuous esophagus. Never seen anything quite like this. Achalasia usually has some fluid, and tapers off distally. This is the whole thing. Middle aged, chest pain.](https://app.figure1.com/case-detail/678bbc1d-c0fe-408d-9e1a-f73e2b67b8bd)