IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Achalasia and tertiary waves

Case contributed by Frank Gaillard
Diagnosis almost certain

Presentation

Dysphagia

Patient Data

Age: Adult
x-ray

This patient with achalasia demonstrates prominent tertiary waves and poor / absent relaxation of the lower esophageal sphincter.

Case Discussion

A barium swallow is able to confirm that:

  • bird beak sign
  • esophageal dilatation
  • pooling or stasis of barium in the esophagus when the esophagus has become atonic or non-contractile (a late feature in the disease)
  • incomplete lower esophageal sphincter relaxation that is not coordinated with esophageal contraction
  • failure of normal peristalsis to clear the esophagus of barium when the patient is in the recumbent position, with no primary waves identified
  • uncoordinated, non-propulsive, tertiary contractions 
  • when barium column is high enough (patient standing) the hydrostatic pressure can overcome the lower esophageal sphincter pressure allowing passage of esophageal content

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.