What’s Wrong With This Picture #3 (Answer):
This chest Xray was posted last week:
This patient came in with a known disorder of achalasia requiring frequent botox injections at his GE junction, but missed his last appointment and was having difficulty swallowing. You can clearly see the outline of the very large proximal esophagus coursing behind the mediastinum. The primary screening method for achalasia is a barium swallow study, usually followed by manometry to confirm the diagnosis. This patient had an endoscopy by the GI team in the ED and had a large food bolus removed with subsequent injection of botox the next day with good symptom resolution.
Author: Nate Parker, MD