CTICasesSevere achalasia (megaesophagus)
Imaging findings
Chest radiograph shows a markedly widened mediastinal contour containing debris and showing a prominent air-fluid level, representing a massively dilated esophagus that tapers at the gastroesophageal junction without an obstructing mass.
Key takeaways
Achalasia can lead to extreme dilatation of the esophageal body (megaesophagus) and food retention, which simulates a mediastinal mass with air-fluid level. Lack of a discrete wall mass and the sheer degree of dilatation help distinguish it from malignant obstruction.
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