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Esophagus: Achalasia Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Esophagus ❯ Achalasia

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  • “Achalasia is a well-recognized oesophageal motility disorder characterized by a combination of absent peristalsis in the thoracic oesophagus and impaired opening of the lower oesophageal sphincter (LES) in response to deglutition.1 Two major forms of achalasia have been described: primary and secondary.”


    Utility of chest CT for differentiating primary and secondary achalasia
 M.Y. Licurse et al.
Clinical Radiology, Volume 69, Issue 10, October 2014, Pages 1019-1026
  • “The primary or idiopathic form is caused by degeneration of myenteric plexi in the wall of the oesophagus. The aetiology of this neural degeneration remains unknown but is postulated to be secondary to viral or autoimmune disease. In contrast, secondary achalasia (also known as pseudo-achalasia) is a less common form caused by extra-oesophageal conditions (especially malignant tumours) that induce an achalasia-like motility disorder by a variety of proposed mechanisms.”


    Utility of chest CT for differentiating primary and secondary achalasia
 M.Y. Licurse et al.
Clinical Radiology, Volume 69, Issue 10, October 2014, Pages 1019-1026
  • “Adenocarcinoma of the gastric cardia or fundus is by far the most frequent malignant tumour that causes secondary achalasia, but lung, breast, pancreatic, and other remote cancers may also be responsible for this condition.” 


    Utility of chest CT for differentiating primary and secondary achalasia
 M.Y. Licurse et al.
Clinical Radiology, Volume 69, Issue 10, October 2014, Pages 1019-1026
  • “Primary achalasia classically occurs in young or middle-aged individuals presenting with long-standing dysphagia but little or no weight loss, whereas secondary achalasia occurs in patients over 60 years of age presenting with recent onset of progressive dysphagia and weight loss.”

    
Utility of chest CT for differentiating primary and secondary achalasia
 M.Y. Licurse et al.
Clinical Radiology, Volume 69, Issue 10, October 2014, Pages 1019-1026
  • “Achalasia is a primary rare motor disorder of the esophagus, with an incidence of about 1/100,000. Symptoms usually become manifest in early adult age, but even children may be affected. Achalasia is characterized by incomplete relaxation of the lower esophageal sphincter (LES) on swallowing and aperistalsis of the esophageal body. In 1947, Ogilvie recognized the syndrome of neoplastic involvement of the distal esophagus that mimicked idiopathic achalasia, with submucosal infiltration of the lower esophagus and cardia by carcinoma, which is now commonly referred to as pseudoachalasia. Therefore, CT can be helpful in differentiating between achalasia and the pseudoachalasia of malignancy.”


    Dedicated multi-detector CT of the esophagus: spectrum of diseases
 Ahmed Ba-Ssalamah et al.
 Abdominal Imaging Jan 2009, Volume 34, Issue 1, pp 3–18
  • “In advanced cases CT shows uniform dilatation that affects a long segment of the esophagus, with no wall thickening and with normal-appearing boundary surfaces and medistinal fat. The esophagus narrows abruptly at the esophagogastric junction with no evidence of an intramural or extrinsic obstructive lesion. In contrast to a stricture, the esophageal wall is not thinned at the site of the narrowing, and the wall is not thickened as it is with the esophageal tumor or esophagitis. Most pseudoachalasia patients have CT findings of esophageal dilation, more marked and/or asymmetric wall thickening, or mass. In this group, asymmetric or marked thickening (>10 mm) indicates pseudoachalasia.”


    Dedicated multi-detector CT of the esophagus: spectrum of diseases
 Ahmed Ba-Ssalamah et al.
 Abdominal Imaging Jan 2009, Volume 34, Issue 1, pp 3–18
  • Achalasia: Facts

    - GE jxn fails to relax due to Wallerian degeneration of Auerbach’s plexus
    - Usually patients age 20-40
    - Symptoms typically are dysphagia and weight loss
  • Achalasia: Facts

    - Recurrent aspiration pneumonia
    - Increased incidence of esophageal cancer
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