PMC3168564_01
(a) An esophagogram showing the dilated esophagus (labeled "E"). The distal esophagus forms a "bird's beak" at the lower esophageal sphincter and contains a column of barium that could not pass into the stomach. (b) Lateral view of dilated esophagus with barium column.
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fig1
A barium esophagogram was negative for esophageal perforation but was consistent with esophageal achalasia (Figure 1).
The Dophoff tube is coiled within the dilated esophagus. The tube's path is outlined with the red arrows.
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fig2
Two attempts failed because the tube could not be passed through the LES but coiled in the large dilated esophagus (Figure 2).
(a) A CT showing a dilated esophagus (labeled "E") and pneumomediastinum (shown with the arrows). There is air, fluid, and solid food within the esophagus. The trachea is labeled "T" for reference. (b) Another CT scan showing the dilated esophagus and the pneumomediastinum.
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fig3
CT scan confirmed the presence of pneumomediastinum (Figure 3), and so pneumatic dilation or Botulinium injections were not considered.
(a) CT of the chest showing the large diaphragmatic hernia (shown by the arrows). The hernia is compressing the left lung and has caused some slight deviation of the trachea to the contralateral side of the chest. (b) Lateral view of diaphragmatic hernia (outlined by arrows) with patient laying supine.
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fig4
A chest CT revealed a large hiatal diaphragmatic hernia with loops of bowel that were compressing the base of the left lung (Figure 4).