Monday, 21 December 2015

xrayoftheweek 51: a barium swallow spot diagnosis

The #xrayoftheweek is this single image from a barium swallow study in someone with long standing dysphagia - what is the name of this classic sign and what is the diagnosis?

This is a classic case of achalasia. The signs seen on a barium swallow study include:

  • tapering narrowing of the lower oesophagus - known as the bird beak sign (see image below)
  • slow passage of barium through the lower oesophageal sphincter which is abnormally tight
  • food residue seen within lower oesophagus
  • tertiary contractions
  • there is a risk of malignancy so the mucosa needs to be carefully evaluated
  • lung parenchyma changes secondary to chronic aspiration
Achalasia may be primary (idiopathic) or secondary to Chagas disease. Pseudoachalasia is the name given to a malignant stricture.

#FOAMed #FOAMrad

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