EURORAD ESR

Case 14900

Achalasia mimicking large paraesophageal hiatal hernia

Author(s)
Siv Mari Sollien Berger

Department of Radiology; Copenhagen University Hospital Hvidovre; Denmark;
email: sssmari_@hotmail.com
 
Patient
male, 67 year(s)
 
 
  • Figure 1
    Dilated esophagus

    Standing position, AP view.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 2
    Filling of intrathoracic cavity

    Standing position, AP view.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 3
    Tertiary contractions

    Standing position, lateral view.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 4
    Intrathoracic cavity with air/fluid/contrast level

    Standing position, AP view, 1 minute past contrast (MPC).

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 5
    Intrathoracic cavity with air/fluid/contrast level

    Standing position, lateral view, 2 MPC.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 6
    Contrast retention in distally dilated esophagus

    Supine position, AP view, 1 HPC.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 7
    Contrast retention and passive reflux.

    Right recumbent position, lateral view, 10 MPC.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Conventional radiography; Fluoroscopy; Procedure: Contrast agent-oral; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 8
    CT scan, chest, AP view

    Intrathoracic cavity (arrows), believed to be hiatal hernia, but proved to be dilated esophagus due to achalasia.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: CT; Procedure: Contrast agent-other; Dynamic swallowing studies; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 9
    CT scan, chest, AP view

    Dilated esophagus (arrows) and intrathoracic cavity to the right.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: CT; Procedure: Contrast agent-other; Special Focus: Dilatation; Motility; Swallowing disorders;
     
     
  • Figure 10
    Recent chest X-ray

    Standing position, AP view, showing intrathoracic cavity with air/fluid level, interpreted as hiatal hernia.

     
    Area of Interest: Gastrointestinal tract; Oesophagus; Imaging Technique: Fluoroscopy; Procedure: Barium meal; Contrast agent-oral; Special Focus: Dilatation;
     
     
Standing position, AP view.
 
Standing position, AP view.
 
Standing position, lateral view.
 
Standing position, AP view, 1 minute past contrast (MPC).
 
Standing position, lateral view, 2 MPC.
 
Supine position, AP view, 1 HPC.
 
Right recumbent position, lateral view, 10 MPC.
 
Intrathoracic cavity (arrows), believed to be hiatal hernia, but proved to be dilated esophagus due to achalasia.
 
Dilated esophagus (arrows) and intrathoracic cavity to the right.
 
Standing position, AP view, showing intrathoracic cavity with air/fluid level, interpreted as hiatal hernia.
 
 
 
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