Pancreatic pseudocyst mimicking idiopathic achalasia

Pseudoachalasia or secondary achalasia is commonly recognized and sought for in the context of an elderly patient presenting with weight loss and brief duration of symptoms. The majority of cases are caused by adenocarcinomas of the fundus or the cardia. It is accepted by gastroenterologists that endoscopy with "routine retroflexion" and biopsy are necessary in any newly diagnosed case of achalasia. Benign causes of pseudoachalasia are extremely rare in this country. In developing countries and South America, Chagas' Disease may mimic achalasia. Herein, we present a case of secondary achalasia linked to an unrecognized mediastinal pancreatic pseudocyst that resolved with appropriate treatment of the underlying cause.