Modified Mondays: Megaesophagus

A very interesting find here: this patient has a “megaesophagus” – a greatly distended esophagus. It’s apparent on this patient right when the fluoro is turned on.  Sometimes they aren’t easily seen until the patient swallows. They can develop in patients with achalasia, which was the case with this particular gentleman. This patient demonstrated coughing with all PO intake and wet vocal quality. A good reminder of how easy it is to mistake esophageal difficulties for pharyngeal dysphagia at the bedside and develop an entirely inappropriate plan of care. Here is also a link to an article with more info: 

https://www.sciencedirect.com/topics/medicine-and-dentistry/megaesophagus