title: Utility of chest CT for differentiating primary and secondary achalasia.
abstract: OBJECTIVE
  To determine the computed tomography (CT) findings of primary and secondary achalasia and to assess the utility of CT for differentiating these conditions.
  
  
  METHODS
  A computerized search revealed 13 patients with primary achalasia and 15 with secondary achalasia who underwent chest CT during a 10-year period. The images were reviewed to determine whether there was distal oesophageal narrowing (including the length/contour of narrowing), oesophageal dilation, oesophageal wall thickening (including degree/symmetry/pattern of thickening), a soft-tissue mass at the gastro-oesophageal junction, mediastinal adenopathy, or other findings of malignant tumour.
  
  
  RESULTS
  Eleven (85%) of 13 patients with primary achalasia had distal oesophageal narrowing at CT that was smooth in all patients; four (31%) had oesophageal wall thickening that was smooth and symmetric in all patients; none had a soft-tissue mass at the gastro-oesophageal junction or mediastinal lymphadenopathy; and two (15%) had pulmonary metastases from unrelated lung cancers. In contrast, 12 (80%) of 15 patients with secondary achalasia had distal oesophageal narrowing at CT; 11 (73%) had distal oesophageal wall thickening that was nodular/lobulate and asymmetric in seven (64%) and smooth and symmetric in four (36%); six (40%) had a soft-tissue mass at the gastro-oesophageal junction; seven (47%) had mediastinal lymphadenopathy; and all 15 had other findings of malignant tumour.
  
  
  CONCLUSIONS
  CT is a useful technique for differentiating primary and secondary achalasia. Distal oesophageal wall thickening that is nodular/lobulate and asymmetric, a soft-tissue mass at the gastro-oesophageal junction, mediastinal lymphadenopathy, and pulmonary, hepatic, or osseous metastases are findings that favour secondary achalasia.
authors: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: M Y
authors: MY
authors: Licurse
authors: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: marc.levine@uphs.upenn.edu.
authors: M S
authors: MS
authors: Levine
authors: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: D A
authors: DA
authors: Torigian
authors: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: E M
authors: EM
authors: Barbosa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D036542:Tomography, Spiral Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007479:Iopamidol