PMC4503585_01
High-resolution manometry study showing hypertensive, nonrelaxing lower esophageal sphincter and aperistaltic esophagus, but with relatively high-amplitude simultaneous pressure changes in the esophageal body.
CRIS2015-328970.001.jpg
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fig1
Her previous test results were reviewed and found to be consistent with type III achalasia (Figure 1).
Esophagram showing classic "bird's beak" tapering with distal narrowing of the esophagus at the gastroesophageal junction with hang-up of contrast.
CRIS2015-328970.002.jpg
PMC4503585_01_CRIS2015-328970.002.jpg
fig2
A injection and balloon dilation at her request (using the same dosage and balloon size as at the initial procedure), but the treatment provided only one month of relief. A subsequent barium esophagram revealed partially treated achalasia, with significant delay in esophageal emptying and a tapered lower esophagus ("bird's beak" sign) (Figure 2).