A 61-Year-Old Male with ‘Just a Cough’

Resolution

Differential Diagnosis

• Diaphragmatic hernia
• Tension pneumothorax
• Dilated esophagus (megaesophagus)
• Scleroderma
• Presbyesophagus

Diagnosis

This patient has a large, dilated-appearing, debris-filled viscus right posteromedial chest, likely dilated esophagus vs colonic interposition. Interposition is less likely, as no clips are seen. Stomach bubble is in a normal location.

The correct diagnosis is dilated esophagus, also called megaesophagus.

Learnings/What to Look for

• Megaesophagus is the end stage of achalasia cardiae. It may occur secondary to achalasia or Chagas disease
• Its cause is peristaltic disorders and slow decompensation of the muscular layer of the esophagus
• Though the patient reported only a cough, other symptoms commonly reported include:
  • difficulty in swallowing food or liquids
  • chest discomfort from retained food

Pearls for Urgent Care Management and Consideration for Transfer

• Treatment for megaesophagus is surgical. Referral to a gastroenterologist is warranted