PMC7145161_01
Chest x-ray depicting soft tissue density in the right paratracheal and pericardiac regions, with no gastric air bubble visualized.
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F1
Chest x-ray demonstrated a large, poorly defined extrapleural soft tissue density in the right paratracheal and pericardiac regions (Figure 1).
Computed tomography showing (A) the dilated and fluid-filled esophagus and (B) compression of the right bronchus.
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F2
Thoracic computed tomography demonstrated a severely dilated fluid-filled esophagus extending from the superior thoracic aperture caudally to the gastroesophageal (GE) junction with associated compression of the right bronchus and left atrium (Figure 2).
Echocardiogram showing the compressed left atrium (arrow) and dilated esophagus (*).
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F3
An echocardiogram demonstrated a normal left ventricular ejection fraction with pseudodyskinesis of the basal inferolateral wall secondary to extrinsic compression and severe compression of the left atrium (Figure 3).
Echocardiogram postesophagogastroduodenoscopy showing resolution of left atrial compression.
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F4
A repeat echocardiogram demonstrated normal left atrial size with reduced extrinsic compression (Figure 4).
Medtronic high-resolution manometry consistent with type 1 achalasia. LES, lower esophageal sphincter.
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F5
Medtronic high-resolution esophageal manometry demonstrated a normal upper esophageal sphincter pressure, a LES pressure of 61.9 mm Hg, an integrated relaxation pressure of 50.3 mm Hg, with no motility or panesophageal pressurization (Figure 5).
Double-contrast esophagram with achalasia demonstrating a sigmoid-shaped esophagus with a severely dilated lumen and a classic bird-peak appearance at the lower esophageal sphincter.
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F6
A double-contrast esophagram was also performed, with findings consistent with a sigmoid-shaped megaesophagus (Figure 6).