Infiltrating carcinoma simulating achalasia

Three cases of carcinoma infiltrating the esophagus and simulating achalasia are presented and the differential diagnostic problems discussed. The radiologic distinction between achalasia and carcinoma can be extremely difficult. Any rigidity, irregularity, nodularity, or ulceration of the distal-most esophagus or gastric fundus or symptoms of short duration in older patients should alert the radiologist to the possibility of carcinoma. It is suggested that all patients with suspected achalasia undergo esophageal and gastric endoscopy with biopsy and esophageal manometry to confirm the diagnosis, expecially if pneumatic dilatation is contemplated.