CT evaluation of achalasia

A retrospective review of CT scans on patients referred with either a definitive or a tentative diagnosis of achalasia was undertaken. Twelve patients were identified, of whom nine had proven achalasia. The remaining three patients were later definitively diagnosed with pseudoachalasia, benign stricture, and leiomyomatosis, respectively. Findings in all nine achalasia patients were similar: moderate to marked esophageal dilatation (mean diameter 4.35 cm at carinal level) with normal wall thickness. Findings are in distinct contrast to the three patients with other diseases, in which the degree of esophageal dilatation and/or wall thickness was atypical. Complications in the patients with proven achalasia included secondary carcinoma (one), iatrogenic esophageal perforation (one), and pulmonary aspiration (three). Computed tomography may not be indicated as a routine study, but in complicated cases CT may be invaluable in confirming the diagnosis or in detecting atypical features that may indicate the presence of other diseases or superimposed benign or malignant processes.