A 14-year-old boy had a several-year history of progressive dysphagia and the recent onset of choking with eating or assuming a recumbent position. The patient was remarkably thin, but physical examination revealed no other abnormality. Results of a complete blood cell count and urinalysis were normal. Chest roentgenograms were obtained (Fig 1).
Denouement and Discussion
The chest roentgenograms showed widening of the paraspinal region, with a fluid level in the superior mediastinum. A barium esophagram (Fig 2) showed retained food and secretions in a dilated esophagus and failure of relaxation of the lower esophageal sphincter. A diagnosis of achalasia was made, and the patient underwent a Heller myotomy and fundoplication, followed by an uneventful recovery and steady weight gain.Achalasia is a disorder of esophageal