CTICasesLung Abscess Secondary to Achalasia
Imaging findings
Initial frontal and lateral chest radiographs showed a vague retrocardiac opacity and abnormality of the posterior tracheal wall and azygoesophageal recess. This finding, initially treated as infection with partial resolution, recurred. Subsequent CT revealed a dilated, fluid-filled esophagus consistent with achalasia, an associated small pleural effusion, and a lower-attenuation, ill-defined mass crossing a fissure, diagnosed as a lung abscess.
Key takeaways
This case illustrates how aspiration secondary to achalasia can lead to recurrent lung abscesses. It highlights the importance of recognizing subtle radiographic signs (posterior tracheal wall thickening, retrocardiac opacity, azygoesophageal recess changes) as clues to underlying esophageal pathology and aspiration risk.
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