Presentation
Intermittent dysphagia for both solids and liquids.
Patient Data
About 100 mL of diluted barium was taken orally; this showed markedly dilated lower two-thirds of the esophagus, barium fluid debris, and air levels were seen in the esophagus. Rather poor esophageal peristalsis in addition to a markedly narrowed lower esophageal sphincter were noted.
Appearances are most consistent with primary esophageal achalasia.
Case Discussion
Achalasia is a motility disorder affecting the esophagus, arising from the degeneration of Auerbach's plexus and resulting in the inability of the gastro-esophageal junction to relax. Typically, this condition manifests between the ages of 20 and 40, and individuals experience difficulty swallowing liquids and solid foods. One distinctive hallmark of achalasia is the recognisable 'rat's tail' or 'bird's beak' appearance observed at the gastro-esophageal junction. An accurate diagnosis relies on confirmation through a manometry study.
Case contributors:
Emad Saleh Tarawneh (Radiology consultant)
Azmy Hadidy (Radiology consultant)
Maher Ahmad Tarawneh (Radiology trainee)
Fatima Abdulsattar Alkubaisi (Radiology trainee)
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