Megaesophagus and possible mechanisms of sudden death.
Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66-year-old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84-year-old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease.
Schalinski
Sarah
S
Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559, Berlin, Germany.
Guddat
Saskia S
SS
Tsokos
Michael
M
Byard
Roger W
RW
D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000473:pathology; D001237:Asphyxia / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D003645:Death, Sudden / Q000209:etiology*; D004931:Esophageal Achalasia / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D008297:Male; D053120:Respiratory Aspiration / Q000209:etiology / Q000473:pathology