[A surgical case of achalasia with empyema]

A 57-year-old man who had been complicated with achalasia for thirty years was admitted because of back pain and low grade fever. Chest X-p and Chest CT showed consolidation in the left lower lung field. His respiratory condition was diagnosed as lung abscess preoperatively. After systemic chemotherapy, surgical management was done for both achalasia and this inflammatory respiratory disease. In the operation by left thoracotomy, it was revealed that this case had empyema, not lung abscess. Thus decortication of left lung and esophagomyotomy were performed simultaneously. In the treatment of achalasia, respiratory complications due to aspiration may appear. In addition, it is sometimes difficult to distinguish empyema from lung abscess preoperatively. Therefore much care should be taken during operation in order to treat these respiratory diseases.