He reported the onset, some months before, of dyspnoea without wheezing while running, which symptom remitted with rest. Furthermore, the boy reported having a nocturnal cough 3–4 times a week for the last 3 months, sometimes associated with the vomiting of gastric contents. In the last 6 months, he had also felt a ‘weight sensation’ at the diaphragmatic level of the thorax and suffered from dysphagia, especially with solid food consumption. His previous medical history was uneventful. The allergological evaluation yielded a positive prick test for dust mites. Furthermore, upon the execution of spirometry tests, a reduced peak expiratory flow rate and an obstructive trend without broncho-reversibility were found. Consequently, the allergist recommended a barium swallow test. A preliminary anteroposterior chest X-ray showed an enlargement of the mediastinum due to a significant oesophageal dilatation with an air-fluid level in the middle and distal thirds of the oesophagus (Fig. The administration of the barium contrast medium confirmed the oesophageal ectasia, with a narrowing of the cardia resulting in a ‘rat-tail’ image (Fig. Notably, the lateral chest radiograph showed an anteriorisation of the trachea. )Ĭhest X-ray: the whole oesophagus appears distended with air-fluid level ( left) Oesophagogram: the swallowed contrast agent accumulates in the oesophagus and the cardia shows a ‘rat-tail’ appearance ( right).Oesophageal peristalsis was not observed however, a minimal and constant passage of barium solution through the oesophageal hiatus was documented without the opening of the lower oesophageal sphincter (LES).
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