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01-07-2021 | Achalasia | Images
Tracheal distortion in achalasia
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2021
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A 77-yr-old 40-kg 171-cm man (who provided written consent for this report) with achalasia (Figure, panel A) presented with postprandial inability to swallow, choking, and suspected aspiration. He was scheduled for esophageal disimpaction.
FIGURE
A) A preoperative frontal posteroanterior chest radiograph taken during barium esophagography shows retention of barium within the lower esophagus (asterisk). Abrupt narrowing of the lower esophagus (dotted line) in keeping with achalasia (“bird’s beak sign”) is seen. The cup of barium (marked “c”) is included in the field of view, extrinsic to the patient. (B–E) Tracheal distortion shown in computed tomography images of the chest three days preoperatively. B) A coronal image in a lung window shows a patulous dilated esophagus filled with retained ingested contents (asterisk) resulting in leftward displacement of the trachea (black arrowhead). C) A sagittal image in a lung window shows anterior displacement of the trachea (white arrowheads) due to the dilated esophagus. D) An axial image in a lung window shows anterior and leftward displacement of the trachea (white arrowheads). There is also some mass effect on the trachea related to an enlarged right thyroid lobe/goiter (asterisk). E) Frontal scout showing a gas-filled structure along the right side of the upper mediastinum with convex borders (white arrowheads), in keeping with the dilated esophagus. There is a resultant mass effect on the trachea, which is displaced and bowed towards the left (dotted line). Abrupt angulation superiorly (black arrowhead) may represent the area of resistance to endotracheal tube advancement. A left pleural effusion is seen (asterisk). F) Frontal posteroranterior chest radiography one day following esophageal disimpaction shows midline positioning of the upper trachea with resolution of previously visualized leftward bowing (dotted line). The right lateral border of the esophagus is also more medially positioned and no longer appears convex (white arrowheads).
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