CTICasesAchalasia Mimicking Trauma
Imaging findings
Frontal and lateral chest radiographs in a trauma patient reveal a large, elongated upper mediastinal abnormality with an air-fluid level extending inferiorly along the posterior aspect of the heart. A barium swallow study initially shows the contrast streaming rapidly down the mucosal folds of a seemingly normal-caliber lumen, but subsequent images reveal massive distention of the esophagus with a classic "bird's beak" narrowing at the gastroesophageal junction without an obstructing mass.
Key takeaways
Achalasia can present as an incidental, dramatic mediastinal mass on chest radiographs in trauma patients. Rapidly streaming contrast down the esophageal wall can initially mask the true degree of esophageal dilation during a barium swallow if the entire lumen is not fully opacified.
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