Airway Obstruction in Achalasia

Chijimatsu, Yoichi; Hasumi, Kazuko; Inatomi, Keiko; Tamura, Masao; Homma, H

doi:10.1378/chest.78.2.348

Cited by 15 publications

(5 citation statements)

References 5 publications

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“…Usually the obstruction results from extrinsic compression on the trachea in the region of the thoracic inlet. Previous reports have demonstrated this compression using plain radiographs of the neck and chest (Bello et al 1950, Chijimatsu et al 1980, Giustra et al 1976, McLean et al 1976, Travis et al 1981. In this report, we describe three cases of upper airway obstruction secondary to achalasia.…”

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confidence: 50%

Radiographic evaluation of acute tracheal obstruction in chalasia

Arnold

Rosenquist

1987

Dysphagia

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Abstract. This report describes the clinical and radiographic features of three patients with achalasia who developed acute upper airway obstruction secondary to dilatation of the esophagus. Computed tomography was especially useful in confirming the diagnoses in two cases. Standard radiographs of the cervical area demonstrated obstruction of the larynx in the third case. In all cases, relief of respiratory distress was achieved by decompression of the esophagus.Key words: Achalasia -Airway obstructionEsophagus.Airway obstruction by the distended esophagus is a recognized complication of achalasia. Usually the obstruction results from extrinsic compression on the trachea in the region of the thoracic inlet. Previous reports have demonstrated this compression using plain radiographs of the neck and chest (Bello et al. 1950, Chijimatsu et al. 1980, Giustra et al. 1976, McLean et al. 1976, Travis et al. 1981. In this report, we describe three cases of upper airway obstruction secondary to achalasia. In two cases, computed tomography (CT) was useful in demonstrating the level of obstruction and the anatomic relationship of the distended esophagus to the trachea. In the third case, radiographic films of the neck demonstrated an unusual level of the obstruction at the larynx. A 74-year-old white female had a 1 year history of solid food dysphagia. She was admitted to the emergency room with acute onset of dyspnea and respiratory failure requiring endotracheal intubation (Fig. 1 a). Subsequently, she had a cardiorespiratory arrest that was treated successfully. Two days after admission, the patient underwent a limited upper GI series that showed a dilated esophagus with no peristalsis. A symmetrical narrowing at the distal esophagus was characteristic of achalasia. Esophagoscopy also demonstrated a dilated esophagus. A superficial biopsy showed normal squamous epithelium. ACT scan of the neck and chest, which was obtained following tracheal intubation, showed a markedly dilated thoracic esophagus with compression of the trachea in the retrosternal region (Figs. 1 b and 1 c). Case 2A 69-year-old Chinese male presented to the hospital with dyspnea and confusion that developed suddenly while he was eating. Esophageal and endotracheal intubation was immediately carried out with relief of respiratory distress. The patient had a history of dysphagia and shortness of breath for the previous 3 weeks. He complained of regurgitation of food for several hours after a meal. Physical examination after stabilization was essentially negative.PA and lateral neck films demonstrated an airfilled saccular structure in the cervical region that was thought to represent a possible Zenker's diverticulum or a dilated cervical esophagus (Fig. 2a). A CT scan of the cervical and thoracic regions

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supporting

confidence: 50%

Radiographic evaluation of acute tracheal obstruction in chalasia

Arnold

Rosenquist

1987

Dysphagia

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“…The intra-thoracic airway obstruction that characterises achalasia mega-oeosophagus has been 17 . The marked hypercapnia in our patient which has been reported in other cases of achalasia megaoesophagus 8 is attributable to very minimal tidal volumes.…”

Section: Discussionmentioning

confidence: 99%

Acute Airway Obstruction Secondary to Achalasia Mega-oesophagus

Whiting

2008

Anaesth Intensive Care

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Acute airway obstruction is a very rare presentation of achalasia. We report the case of a 78-year-old woman with previously undiagnosed achalasia who presented with acute respiratory distress and stridor due to tracheal compression by mega-oesophagus. Anaesthetists and physicians caring for patients with achalasia must be aware of the need for emergency oesophageal decompression in this rare and life-threatening condition.

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“…The former may be associated with glossopharyngeal neuralgia [1], the latter may be a result of mechanical irritation caused by esophageal distension or spasm, thereby inducing intense vagal afferent activation [10][11][12][13][14]. Esophageal distension can be profound in achalasia; thus, esophageal compression can cause respiratory distress through the compression of the trachea and recurrent laryngeal nerve paralysis, especially in mega-esophagus caused by achalasia [15][16][17][18]. In our patient, syncope accompanied swallowing, suggesting that the afferent pathway is within the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Swallow-Induced Syncope in a Patient with Achalasia

2005

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A 48-year-old man was referred for the evaluation of dysphagia and syncope. He suffered from both dysphagia and transient loss of consciousness when eating solid food, especially bread. An upper gastrointestinal barium examination and esophageal manometry suggested achalasia. Ambulatory ECG revealed marked sinus bradycardia when experiencing a syncopal episode following the ingestion of a solid meal. A permanent pacemaker was implanted and the patient's syncopal attacks were relieved following this procedure. However, the dysphagia and cardiac arrhythmia completely disappeared only following a successful pneumatic balloon dilatation for achalasia. This observation suggests that swallowing-induced sinus bradycardia and syncope might occur in the course of achalasia and these rhythm abnormalities could be relieved by successful treatment of the achalasia.

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Airway Obstruction in Achalasia

Cited by 15 publications

References 5 publications

Radiographic evaluation of acute tracheal obstruction in chalasia

Radiographic evaluation of acute tracheal obstruction in chalasia

Acute Airway Obstruction Secondary to Achalasia Mega-oesophagus

Swallow-Induced Syncope in a Patient with Achalasia

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