achalasia barium swallow

This women in her 20’s presented with grave difficulties swallowing both food and liquids.

Achalasia is a oesophageal motility disorder due to failure of relaxation of the lower oesophageal sphincter. This occurs due to an abnormality within the Auerbach’s plexus – be it primary or secondary.

Baruim swallow demonstrates:

1. Beaked tapering of the oesophagus at the gastro-oesophgeal junction

2. A grossly dilated oesophagus

3. Tertiary contractions

4. Air-fluid level on the control/plain film

Key Points:

a. Achalasia is associated with an increased risk of oesophageal malignancy

b. Beware of pseudoachalasia due to destruction of the plexus by tumour such as linitis plastica

c. The radiologist has a role in treatment by ballon dilatation

Reference: Primer in Diagnostic Imaging, Weissleder et al, Mosby.

Credit: Dr Ian Bickle