Achalasia

Achalasia is a disorder of esophageal dysmotility due to failure of the gastroesophageal sphincter to relax because of destruction of its myenteric plexus. Primary achalasia is considered idiopathic while secondary achalasia could be due to destruction of the myenteric plexus by tumor or infection (Chagas disease). The radiologic diagnosis of primary achalasia is best made with barium studies which will show marked dilation of the esophagus with smooth narrowing near the GE junction (bird's beak deformity). Real time imaging will also show absent primary peristalsis and the presence of tertiary contractions. While cross sectional imaging is not the most sensitive in diagnosing achalasia, sometimes the finding is made incidentally as in the above case. The differential diagnosis of achalasia was previously discussed here.


REFERENCES
Noh MH, Fishman EK, Forastiere AA, et al. CT of the esophagus: spectrum of disease with emphasis on esophageal carcinoma. Radiographics 1995;15:1113-34.
Woodfield CA, Levine MS, Rubesin SE, et al. Diagnosis of primary versus secondary achalasia: reassessment of clinical and radiographic criteria. AJR Am J Roentgenol 2000;175(3):727-31.