Differentiation of Achalasia from Pseudoachalasia by Computed Tomography.

Carter, Michele; Deckmann, Robert C.; Smith, Robert C.; Burrell, Morton I.; Traube, Morris

Objectives: The purpose of this study was to determine the computed tomography (CT) findings in idiopathic achalasia and in the pseudoachalasia of malignancy. Methods: We identified 12 patients with the manometric diagnosis of achalasia who also had CT scare available for review: eight had idiopathic achalasia, and four had pseudoachalasia. As controls, we selected nine patients with endoscopically obvious esophageal cancer who also had CT scans. The CT scans were blindly reviewed to determine esophageal wall thickness, symmetry of the esophageal wail presence of esophageal dilation or mass, and a radiological diagnosis. Results: Six of the eight patients with achalasia had a dilated esophagus. Five had symmetric wall thickening >5 mm (range 7-10 mm) at the gastroesophageal junction. One patient with a 10-ram wall thickening was incorrectly diagnosed with a mass. All others were correctly diagnosed with achalasia. Three of the four patients with pseudoachalasia had esophageal dilation. Two had an obvious esophageal mass. The other two were given an indefinite diagnosis: one had asymmetric wall thickening (11 mm) at the gastroesophageal junction, and the other had symmetric thickening of 18 mm. Eight of the nine patients with obvious esophageal cancer had a mass on CT; the other patient had asymmetric wall thickening of 6 mm at the gastroesophageal junction and was given an indefinite diagnosis. Conclusions: Most achalasia patients have CT findings of esophageal dilation and mild, symmetric wall thickening. Therefore, symmetric esophageal wall thickening (10 nun) indicated pseudoachalasia. Therefore, CT can be helpful in differentiating between achalasia and the pseudoachalasia of malignancy.

GASTROINTESTINAL diseases; ESOPHAGEAL cancer; MEDICAL radiography; TOMOGRAPHY; CANCER patients

American Journal of Gastroenterology (Springer Nature), 1997, Vol 92, Issue 4, p624

0002-9270

Academic Journal