["Cardiomegaly and pneumonia"--a misdiagnosis in long-standing achalasia].
METHODS
A 65-year-old woman was admitted to another hospital with suspected status asthmaticus. While there was progressive respiratory failure, the chest X-ray showed bilateral congestion and infiltration with widened mediastinum and cardiomegaly. The patient was transferred to the authors' hospital after two days on ventilatory support because of suspected left-ventricular failure and pulmonary congestion with pneumonia. 30 years previously she had undergone a myotomy for achalasia.


METHODS
Imaging of the oesophagus with water-soluble contrast medium, computed tomography of the thorax and gastroscopy revealed a siphon-like megaoesophagus (which had been misinterpreted radiologically as cardiomegaly) with a slightly open lower oesophageal sphincter. The pulmonary symptoms were thought to be due to aspiration pneumonia.


METHODS
As there were no other reasonable treatment options a transmediastinal oesophageal resection with gastric pull-through and collar anastomosis was performed.


CONCLUSIONS
In long-standing achalasia a megaoesophagus can develop despite previous myotomy. It should be included in the differential diagnosis of radiologically demonstrated mediastinal enlargement.
Endlicher
E
E
Klinik und Poliklinik für Innere Medizin, Universität Regensburg.
Fürst
A
A
Strotzer
M
M
Messmann
H
H
Kerner
T
T
Schölmerich
J
J
Lock
G
G
D000368:Aged; D000714:Anastomosis, Surgical; D006332:Cardiomegaly / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D012086:Reoperation; D013224:Status Asthmaticus / Q000175:diagnosis / Q000209:etiology