Respiratory failure due to achalasia cardia

Summary 

A 76-year-old male was seen in our hospital for hypoxic respiratory failure and bronchorrhea worsening over a few weeks. He failed treatment with antibiotics and diuretics. A CT scan of the chest was performed which revealed a dilated esophagus with an air-fluid level with evidence of aspiration. A contrasted upper GI series revealed typical “birds beak” appearance of achalasia. He was treated with botulinum injections into lower esophageal sphincter and his hypoxemia resolved. Achalasia is a lesser known cause of aspiration which can lead to respiratory failure. We have discussed the wide spectrum of aspiration syndromes seen in the setting of various swallowing disorders.

Keywords: Achalasia, Respiratory failure, Aspiration, Pneumonitis, Pseudoachalasia, Botulinum