Imaging description

Nonspecific esophageal distention is the predominant CT finding of achalasia and esophageal scleroderma. Fluoroscopic esophagram demonstrates the key findings of achalasia: absent peristalsis in the lower two-thirds of the esophagus, tapered (beak-like) narrowing of the distal esophagus, and intermittent drainage of barium through the gastroesophageal junction in the upright position (Figure 42.1). Esophageal peristalsis is also absent in patients with scleroderma; however, the esophagram typically demonstrates a distal esophageal stricture (Figure 42.2), secondary to chronic reflux esophagitis, rather than tapered narrowing of the distal esophagus. When present on CT, the pulmonary findings of scleroderma suggest the cause of esophageal dilatation (Figure 42.3).