MyPACS.net: Radiology Teaching Files > Case 7445961

previously visited 061128 VIGOROUS ACHALASIA
Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 3 year old male
History: Intermittent abdominal pain for days.
Vomit(+). Fever(-).
Constipation for long time.
History of umbilical hernia post surgery.
Images:[small]larger

Fig. 1: KUB

Fig. 2: UGI

Fig. 3: UGI

Fig. 4: UGI

Fig. 5: CT_Cor

Fig. 6: CT_Cor

Fig. 7: CT_Animator

Fig. 8: LGI

Fig. 9: LGI_Follow up

Fig. 10: Surgery

Fig. 11: Surgery
Findings:

KUB:
 1. Much stool in colon.
 2. Scoliosis along L-spine with hemivertebrae in lower L-spine.

UGI(Barium swallow):
 1. Marked smooth dilatation of esophagus with air-contrast level
    due to lower esophagus segmental lumen narrowing and absence of
    esophageal peristalsis.

CT with IV contrast:
 1. Abnormal hight position of right kidney without hydronephrosis
    in right sub-phrenic region, in favor of renal ectopy.
 2. Scoliosis along L-spine with a right extra-hemivertebrae
    in L3/L4.

LGI(Barium enema):
 Well-distention of rectum without segmental narrowing.

Surgery:
 Myotomy and fundoplication.

Diagnosis: 1. Vigorous achalasia
2. Right renal ectopy
3. Hemivertebrae, L-spine
Discussion: About esophagus:
1. Barium swallow revealed findings similar achalasia except a short segmental spasm / narrowing in lower esophagus.
2. Endoscopy (not showed) revealed smooth mucosa before obstruction, less likely esophageal stricture secondary to gastroesophageal reflux with esophagitis.
3. Esophageal manometry was not performed in our case.
4. The patient received surgery with myotomy and fundoplication smoothly.
Comments:
No comments posted.
Additional Details:

Case Number: 7445961Last Updated: 12-04-2006
Anatomy: Gastrointestinal (GI)   Pathology: Other
Modality: CT, Conventional Radiograph, GI, Photograph, 3D ReconstructionAccess Level: Readable by all users
Keywords: vigorous achalasia, esophagusACR: 715.745

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