Final Diagnosis -Insta and FB post

 

                  Final Diagnosis:

Achalasia with Megaesophagus (Advanced Stage).

🔍 Radiologic Evidence:

🩻 Chest X-ray (Image 3):



  • Shows a widened mediastinum with a long, tubular opacity.
  • Evidence of air-fluid level and mottled density, suggestive of retained food/debris in a dilated esophagus.
  • Esophagus appears greatly dilated, deviating slightly to the left — classic for chronic achalasia.

📸 CT Scan (Images 1 & 2 – Coronal and Sagittal):




  • Demonstrates a massively dilated esophagus filled with fluid, food debris, and gas.
  • No discrete mass or stricture is visible, helping rule out malignancy (pseudoachalasia).
  • The esophagus extends well below the carina, almost to the gastroesophageal junction, with a characteristic tapered narrowing at the LES ("bird beak" sign may be inferred on barium).

🧠 Clinical Correlation:

  • 10-year history of progressive dysphagia to both solids and liquids.
  • Worsening over the last 6 months, possibly due to increased food retention or secondary inflammation.
  • Typical presentation of end-stage achalasia, also called sigmoid esophagus in severe cases.

🚨 Key Points:

  • This is a classic teaching case of untreated or late-stage achalasia.
  • Must rule out esophageal carcinoma by endoscopy/biopsy, as pseudoachalasia can mimic this appearance.
  • These patients are at risk of aspiration, malnutrition, and esophageal rupture if untreated.


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