A rare manifestation of achalasia: huge esophagus causing tracheal compression and progressive dyspnea

Achalasia is a primary esophageal motility disorder characterized by the absence of primary peristalsis and a failure of the lower esophageal sphincter to relax, resulting in a dilated esophagus. Dysphagia is the classic and most common symptom. Respiratory obstruction due to tracheal compression caused by a massively dilated esophagus is a very rare but fatal complication. Herein, we report a case of a patient with long-standing achalasia who had tracheal compression secondary to a markedly dilated, giant esophagus. These findings are documented with CT scans. His symptoms regressed after a Heller myotomy and fundoplication operation.