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Achalasia-associated megaoesophagus presenting with dyspnoea and cough
  1. Amro Abu Suleiman1,
  2. Daniel James1,
  3. Alexander Wilkins1,
  4. Adrian Van Bladel2 and
  5. Terence Lo1
  1. 1Department of Upper Gastrointestinal Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
  2. 2Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Dr Amro Abu Suleiman; amro.a.suleiman{at}gmail.com

Abstract

We present an unusual case of achalasia presenting with dyspnoea and persistent cough. These symptoms persisted for months, leading to the patient undergoing a chest X-ray by her general practitioner which showed right basal consolidation and a density extending along the right mediastinum. CT scan was done which revealed megaoesophagus with a diameter of 7 cm causing tracheal compression, as well as right basal consolidation, consistent with aspiration. Further history revealed 6-month history of progressive swallowing difficulty, retrosternal chest pain and shortness of breath which worsened when eating solid foods. After thorough workup, a diagnosis of idiopathic achalasia (type II) was made. She was treated with laparoscopic Heller cardiomyotomy and Dor fundoplication with significant improvement at follow-up. Dyspnoea and respiratory symptoms are unusual presenting symptoms, suggesting a need to consider achalasia in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis and intervention prior to oesophageal failure.

  • Oesophagus
  • Gastrointestinal surgery
  • General surgery
  • Gastroenterology

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Footnotes

  • Contributors Drafting of the text: AAS, DJ and AVB. Sourcing and editing of clinical images and investigation results: AAS, DJ and TL. Critical revision for important intellectual content: AW and TL. All authors gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.