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Case Reports
. 2024 Feb 17;17(2):e258950.
doi: 10.1136/bcr-2023-258950.

Achalasia-associated megaoesophagus presenting with dyspnoea and cough

Amro Abu Suleiman  1 , Daniel James  2 , Alexander Wilkins  2 , Adrian Van Bladel  3 , Terence Lo  2
Affiliations
Case Reports

Achalasia-associated megaoesophagus presenting with dyspnoea and cough

Amro Abu Suleiman et al. BMJ Case Rep. .

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.

Keywords: Gastroenterology; Gastrointestinal surgery; General surgery; Oesophagus.

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Conflict of interest statement

Competing interests: None declared.

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