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