Pediatric Achalasia

Etiology: Contraction of lower esophageal sphincter
Imaging UpperGI: Dilated fluid-filled esophagus that terminates in a narrow bird’s beak above the gastroesophageal junction
DDX:
Complications: Aspiration pneumonia
Treatment: Esophageal dilation or surgery
Clinical:

Radiology Cases of Achalasia

CXR and upper GI of achalasia — CXR PA and lateral (above) shows a dilated esophagus with an air-fluid level within it. AP and lateral images from an upper GI (below) show an extremely dilated esophagus with fluid-fluid level within it that terminates in a beak at the gastroesophageal junction.

Upper GI of achalasia — Three lateral images from an upper GI exam shows dilation of the proximal esophagus which narrows to a beak distally which never opens up. A barium pill would not pass through the distal esophagus into the stomach.

Upper GI of pediatric achalasia — AP images from an upper GI exam show an extremely dilated esophagus with a fluid-fluid level within it (left) that terminates in a beak at the gastroesophageal junction (right).