doiSerbia

"Stray" achalasia: From gastroenterologist to pulmonologist and back

Obradović Dušanka (Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic - High Dependency Unit, Sremska Kamenica)
Joveš-Sević Biljana (Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic - High Dependency Unit, Sremska Kamenica)
Stojanović Miloš (Institute for Pulmonary Diseases of Vojvodina, Radiology Department, Sremska Kamenica)
Ilić Miroslav (Institute for Pulmonary Diseases of Vojvodina, Thoracic Surgery Clinic, Sremska Kamenica)
Ivanov Igor (Institute for Cardiovascular Diseases of Vojvodina, Coronary Care Unit, Sremska Kamenica)

Introduction. Achalasia is a rare esophageal disorder which, due to frequent presence of both respiratory and gastrointestinal symptoms, can initially be referred either to pulmonologist or gastroenterologist. Case Outline. A 50-year-old patient was initially referred to gastroenterologist with the following symptoms: nausea, vomiting, occasional hiccups, weight loss, chest pain, dysphonia, and dry cough. After chest X-ray, the patient was referred to pulmonologist with differential diagnosis for pulmonary infiltration and thoracic aortic aneurysm. Pulmonologist interpreted chest X-ray as showing paratracheal mediastinal enlargement with air-fluid levels, thus suspecting achalasia. Computed tomography scan of the thorax with per os contrast showed extremely dilated esophagus with food stasis. The patient was then referred to thoracic surgeon, who ordered additional diagnostics (esophageal passage with contrast, esophagomanometry, esophagogastroduodenoscopy), and finally performed Heller myotomy. Postoperatively there were no complications, and the patient was symptom free during the follow-up. Conclusion. Although achalasia can also result in respiratory symptoms, fastidious anamnesis and accurate radiological interpretation are essential for the correct diagnosis.

Keywords: achalasia, chest pain, dysphonia