End-stage Esophageal Achalasia as Incidental Finding After Thoracic Trauma

The patient is a 55-year-old man with no digestive or respiratory symptoms. A chest radiograph due to rib trauma revealed mediastinal widening as an incidental finding (Fig. 1). Thoracic CT scan identified notable esophageal dilation in the upper and middle thirds (Fig. 2). Gastroscopy ruled out tumor pathology, and manometry was not evaluable. Esophagogram showed moderate dilatation of the esophageal body and a sharp appearance of the cardias, compatible with advance-stage achalasia. Given the clinical stage, a minimally invasive McKweon esophagectomy was performed. The pathological study identified collagenous fibrosis in the submucosa and chronic inflammatory infiltrate around the myenteric plexuses. The postoperative evolution was without incident.

Fig. 1

Fig. 2

Final Diagnosis

Advanced-stage esophageal achalasia