Tracheal obstruction secondary to esophageal achalasia.

A 12-year-old girl presented with cough, emesis, and weight loss of 18-month duration. She was diagnosed as having achalasia of the esophagogastric junction. Flow-volume loops done because of the cough revealed a configuration consistent with variable intrathoracic tracheal obstruction. A barium swallow revealed the cause of obstruction to be massive dilatation of the esophagus. Balloon dilatation of the esophageal sphincter resolved all symptoms and normalized the flow-volume loops. This case illustrates that some pulmonary symptoms in achalasia can be due to direct tracheal obstruction in addition to the usual aspiration of esophageal contents.