- A 48yo woman is admitted to ED with a productive cough and moderate fever. She has often
central chest pain and regurgitation of undigested food most times but doesn’t suffer from acid
reflux. These symptoms have been present for the last 3.5 months which affects both food and
drink. A CXR shows an air-fluid level behind a normal sized heart. What is the most likely dx?
a. Pharyngeal pouch
b. Hiatus hernia
c. Bulbar palsy
d. Achalasia
e. TB
Q. 1. What is the key?
Q. 2. What are the points in favour?
Ans. 1. The key is D. Achalasia.
Ans. 2. Points in favour: Aspiration pneumonia due to retained food and fluid in oesophagus. In
achalasia usually there is no acid reflux. Dysphagia for both food and drink. Air-fluid level behind heart.