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Case Reports
. 2025 Jan 12;17(1):e77308.
doi: 10.7759/cureus.77308. eCollection 2025 Jan.

Diagnosis and Monitoring of Achalasia Utilizing Point-of-Care Ultrasound (POCUS): A Case Report

Yupar Linn  1 , Phyu Phyu Han  1 , Kian Chai Lim  2   3 , Vui H Chong  1   4
Affiliations
Case Reports

Diagnosis and Monitoring of Achalasia Utilizing Point-of-Care Ultrasound (POCUS): A Case Report

Yupar Linn et al. Cureus. .

Abstract

Achalasia is a rare disorder affecting the esophagus, in which the lower esophageal sphincter (LES) is spastic and fails to relax, causing food retention. This leads to esophageal dilatation over time. The condition often presents late and is frequently not suspected, resulting in delayed diagnosis. Traditionally, it is diagnosed through manometry, which shows failure of relaxation of the LES, along with ineffective or absent peristalsis. Barium swallow imaging reveals the pathognomonic "rat's tail" sign and a dilated esophagus. We report an interesting case of achalasia that was initially suspected on chest radiography, diagnosed using point-of-care ultrasound (POCUS), and later confirmed with a computed tomography scan. The patient improved after two sessions of balloon dilation, and monitoring with POCUS showed improvement. This case highlights the potential role of POCUS in both the diagnosis of achalasia and in monitoring after treatment.

Keywords: achalasia cardia; esophageal achalasia; monitoring; point-of-care ultrasound; ultrasound (u/s); ultrasound diagnosis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Electrocardiogram done on admission, showing only sinus tachycardia
aVL: augmented vector left; aVR: augmented vector right; aVF: augmented vector foot
Figure 2
Figure 2. Plain chest radiograph showing a convex widening of the right mediastinal border (solid arrows), with air-fluid level (open arrows) suggestive of a grossly dilated esophagus, and absent gastric bubble (*)
Figure 3
Figure 3. POCUS at the epigastrium level using the liver as acoustic window showing (a) dilated distal esophagus with fluid content located posterior to the liver. (b) Corresponding drawing illustration of the POCUS image
POCUS: point-of-care ultrasound; IVC: inferior vena cava; HV: hepatic vein *Gastroesophageal junction Image credit: Figure 3b is an original image created by the author Vui H. Chong
Figure 4
Figure 4. POCUS at the cervical esophagus. (a) Transverse view showing a dilated cervical esophagus measuring 26.4 mm with reverberation artifacts due to air inside the esophagus with corresponding drawing illustration showing the structures. (b) Sagittal view of the scan showing a dilated esophagus up to the UES and the corresponding drawing illustration showing the structures. Reverberation artifacts due to air inside the esophagus highlighted by small white arrows and thickened esophageal wall (*)
POCUS: point-of-care ultrasound; UES: upper esophageal sphincter Image credit: The corresponding drawing illustrations are original images created by the author Vui H. Chong
Figure 5
Figure 5. Coronal CT image showing a grossly dilated fluid-filled esophagus (*) extending up to the neck
CT: computed tomography
Figure 6
Figure 6. Upper gastrointestinal endoscopy showing a dilated esophagus with food residue and lower esophageal sphincter spasm, prior to balloon dilation. Gastroesophageal opening is indicated by an arrow
Figure 7
Figure 7. POCUS of a normal cervical esophagus located posterior to the left lobe of the thyroid gland in the (a) transverse view appearing as a ring structure (white arrow) and (b) sagittal view appearing as a layered tubular structure with reverberation artifacts from content inside the esophagus
POCUS: point-of-care ultrasound; Eso: esophagus; Tra: trachea; Thy: thyroid; Ca: carotid artery; M: muscles
See this image and copyright information in PMC

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