Contrast and Radiological Procedures — MCQs

Question 261: A 30-year-old female patient presents with nonprogressive dysphagia for both solids and liquids. The characteristic finding on barium swallow that will confirm the probable diagnosis is:

• A. Irregular narrowing of the esophageal lumen
• B. Ulceration with stricture in the esophagus
• C. Multiple sacculations and pseudodiverticulae in the esophagus
• D. Dilated esophagus with a tapering lower end (Correct Answer)

Explanation: ***Dilated esophagus with a tapering lower end*** - This description, often referred to as a **"bird's beak"** or **"rat's tail"** appearance, is characteristic of **achalasia** on barium swallow. - Achalasia is a motility disorder where the **lower esophageal sphincter (LES) fails to relax**, and there is a loss of peristalsis in the esophageal body, leading to dilation and dysphagia for both solids and liquids. *Irregular narrowing of the esophageal lumen* - **Irregular narrowing** is more suggestive of an **esophageal tumor** or a **malignant stricture**, which would typically present with progressive dysphagia, primarily for solids. - The dysphagia described in the patient is nonprogressive for both solids and liquids, making a malignant stricture less likely. *Ulceration with stricture in the esophagus* - The presence of **ulceration and stricture** is commonly seen in **peptic strictures** due to **gastroesophageal reflux disease (GERD)** or **esophagitis**, which usually cause progressive dysphagia and heartburn. - This presentation does not fit the patient's nonprogressive dysphagia for both solids and liquids. *Multiple sacculations and pseudodiverticulae in the esophagus* - **Multiple sacculations and pseudodiverticulae** are characteristic findings in **diffuse esophageal spasm**, where uncoordinated, high-amplitude contractions occur. - While diffuse esophageal spasm can cause dysphagia and chest pain, the classical barium swallow finding is a **"corkscrew esophagus"**, not the dilated esophagus seen in achalasia.