Megaesophagus in the pediatric age group: a diagnostic dilemma

ABSTRACT

A 5-year-old boy weighing 8 kg presented with recurrent pulmonary infections, occasional nonbilious vomiting, intermittent cough, and failure to thrive since birth. On physical examination, vital signs were normal, but on auscultation left-sided fine crackles were found. The child was anemic, other blood biochemistry levels were within the normal range. A chest X-ray and computed tomography [CT] revealed bronchiectasis localized to the left hemithorax and a radiolucent air column within a distended esophagus. Other causes of chronic pulmonary diseases, such as cystic fibrosis, congenital immune deficiencies and primary ciliary dyskinesia were excluded. A barium swallow demonstrated a dilated esophagus with an air-fluid level and sudden narrowing at the distal end [Figure 1]. Esophageal manometry showed uncoordinated, low-amplitude peristalsis of the esophageal body and the lower sphincter pressure was normal