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Weekly Chest CasesArchive of Old Cases

Case No : 983 Date 2016-08-29

  • Courtesy of Inyoung Song, Jeong Geun Yi, Jeong Hee Park / Konkuk University Medical Center, Konkuk University School of Medicine
  • Age/Sex 71 / M
  • Chief ComplaintIncidental abnormalities detected on chest radiograph
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Achalasia
Radiologic Findings
Posteroanterior chest radiograph shows a huge mass-like opacity with air-fluid level in right paratracheal and paravertebral area. The right heart silhouette is intact.
Axial images of contrast-enhanced chest CT also show diffuse, extensive dilatation of esophagus with food stagnation
Brief Review
Achalasia is a well-recognized esophageal motility disorder characterized by a combination of absent peristalsis in the thoracic esophagus and impaired opening of the lower esophageal sphincter (LES) in response to deglutition. Two major forms of achalasia have been described: primary and secondary. The primary or idiopathic form is caused by degeneration of myenteric plexi in the wall of the esophagus. The etiology of this neural degeneration remains unknown but is postulated to be secondary to viral or autoimmune disease. In contrast, secondary achalasia (also known as pseudo-achalasia) is a less common form caused by extra-esophageal conditions (especially malignant tumors) that induce an achalasia-like motility disorder by a variety of proposed mechanisms.
Characteristic imaging findings are as follows; 1) huge mass shadow in right paracardiac area with intact right heart silhouette on chest radiograph, 2) Markedly dilated esophagus with mild diffuse wall thickening on CT and 3) markedly distended esophageal lumen with abrupt but smooth tapering at GE junction level (terminal beak sign) on esophagography.
References
1. Diseases of the Esophagus: Diagnosis with Esophagography Radiology 2005; 237:414–427
2. Achalasia: new perspectives on an old disease Neurogastroenterol Motil 2016; 28, 4–11
Please refer to
Case 112 Case 961
Keywords
Esophagus, Others,

No. of Applicants : 90

▶ Correct Answer : 30/90,  33.3%
  • - Otsu Municipal Hospital , Japan Noriatsu Ichiba
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - university of montreal , Canada Andrei Gorgos I
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Qatif Central Hospital , Saudi Arabia Hani Alsalam
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - 異⑸ , Korea (South) 蹂€
  • - Chungbuk national university , Korea (South) Yong Kim
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Asan Medical Center , Korea (South) Chan Ho Park
  • - Konkuk University Medical Center , Korea (South) Yong Kwon
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Private sector , Greece Vasilios Tzilas
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - stanley medical college , India yazhini v
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
▶ Correct Answer as Differential Diagnosis : 11/90,  12.2%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - University of ottawa , Canada Subramaniyah Ramanathan
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - 異⑸ , Korea (South) Junghwan Kim
  • - medical university of isfahan , Iran pouya akbari
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - GHICL , France manuel toledano
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
▶ Semi-Correct Answer : 1/90,  1.1%
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
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