Acute airway compression with achalasia.

摘要

Respiratory distress, dysphagia, and neck swelling developed in a 72-year-old woman who was known to have achalasia. Symptoms developed immediately after vomiting, and the patient presented with worsening breathlessness, stridor, and hoarseness of voice. Examination revealed a left-sided uncom-pressible neck mass and signs of respiratory distress. The most recent surveillance endoscopy had shown a baggy esophagus, 35 cm to the esophageal-gastric junction, without esophageai obstruction.Chest x-ray (A) confirmed the presence of a tortuous, dilated, and baggy esophagus (A, arrows show outline of the dilated esophagus). Lateral neck x-ray (B) showed a distended esophagus compressing the trachea (bottom arrow) and displacing the laryngeo-tradheal complex anteriorly (B, top arrow). CT scan revealed herniation of the distended esophagus posteriorly behind the oropharynx to the level of the nasopharynx, deviating the trachea, and compressing the upper part of the esophagus. CT scan also showed distal esophageai complete obstruction at the gas-troesophageal junction. There was no evidence of pneumo-thorax or esophageai rupture.