Achalasia Cardia an Unusual Presentation as a Large Neck Swelling

Objective: Here we report a case of achalasia cardia with extremely unusual presentation of a large neck mass on the right side of neck. Method: Case report and a short review of literature concerning unusual presentations of achalasia cardia. Results: 80 years old female presented with progressive dysphagia for one year along with aspiration, regurgitation of food and weight loss. On examination there was a single swelling on right side of neck measuring about 10 x 5 cms, extending from mid sternocleidomastoid to clavicle. X-ray chest showed unusually large paramediastinal mass running parallel to the right mediastinal border, showing central lucencies. CT scan neck and thorax showed unusually gross dilatation of the cervical and thoracic oesophagus. The unique features of this case was an enormously enlarged oesophagus, palpable in neck on right side and causing airway compression Conclusion: It is unusual for achalasia cardia to present with such a huge neck swelling clinically as well as on CT scan. This case shows how varied can be the presentation of mega oesophagus in achalasia cardia.