Left Atrial Compression Secondary to Massive Esophageal Dilatation in a Patient With Idiopathic Achalasia

Felix, Alex dos Santos; Quintes, Ananda Costa; Sá, Gabriella Andrade de; Adachi, Marcelo Ryoma; Fittipaldi, Viviane; Siciliano, Ana Paula dos Reis Velloso

doi:10.1016/j.case.2018.07.002

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…1) The compression beside LA can lead to low cardiac output, dyspnea, chest pain, pulmonary congestion, palpitation, hemodynamic instability, and even heart failure. 1,3,4,5) However, compared to congestive heart failure with LA enlargement, this type of heart failure and pulmonary edema is due to reducing LA volume and increasing refilling pressure. 1,3,5) Apart from the above symptoms, some literature presented that patients may experience repeated syncope and arrhythmia.…”

Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

“…1,3,4,5) However, compared to congestive heart failure with LA enlargement, this type of heart failure and pulmonary edema is due to reducing LA volume and increasing refilling pressure. 1,3,5) Apart from the above symptoms, some literature presented that patients may experience repeated syncope and arrhythmia. 6,7) From the patient's history and Holter report, the paroxysmal atrial fibrillation attack was likely associated with food intake.…”

Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

“…Clinically, to differentiate gastrointestinal origins of extrinsic LA compression from the other mediastinal structures, the combination of the TTE and carbonated beverage swallow tests may provide a useful approach. 5) Furthermore, TTE can also be used to determine the effectiveness of treatment afterward. 18) The blood flow assessment, vascular structure, and turbulent flow in the chambers are critical in the differential diagnosis.…”

Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

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A Rare Cause of Left Atrium Compression

et al. 2021

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Extrinsic compression of the left atrium (LA) due to esophageal achalasia has been considered a rare occurrence. Patients might present with dysphagia, dyspnea, and even hemodynamic compromise simultaneously. Prompt detection with a thorough differential diagnosis is crucial for subsequent management. In this case report, we present a patient with LA compression by esophageal achalasia and performed a literature review to gather information as regards the clinical manifestation, diagnosis, and treatment strategy of this rare disease.A 59-year-old man with intermittent palpitation, heartburn sensation, and difficulty swallowing came to our emergency department due to acute onset of chest compression and breathlessness after a large meal. As per his chest X-ray, dilated mediastinum and small gastric bubble were noted. Electrocardiogram implied left atrial enlargement, and the Holter monitor reported one episode of paroxysmal atrial fibrillation attack during his meal. Transthoracic echocardiogram showed a round-shaped, well-bordered, hyperechogenic, and heterogeneous mass compressing the LA irrespective of the systolic or diastolic phase. A chest contrast-enhanced computed tomography scan was then performed, wherein it showed diffuse esophageal dilatation with a smoothly thickening wall aligned compressing the LA. Meanwhile, the barium swallow esophagogram revealed contrast pooling at the esophagogastric junction with a bird beak shape. Accordingly, extrinsic compression of LA by esophageal achalasia was diagnosed.Esophageal achalasia compressing LA has been considered rare. Remarkably, given that a patient is presenting with dysphagia and concurrent chest tightness, palpitation, and dyspnea after swallowing food, the clinicians should keep this diagnosis in mind. Careful history review to clarify the causal relationship between the symptoms, specific findings on electrocardiogram and chest X-ray, and utilization of echocardiography and esophagography are beneficial for a prompt and accurate diagnosis.

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Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

Section: La Compression By Extrinsic Masses Is Uncommonmentioning

confidence: 99%

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A Rare Cause of Left Atrium Compression

et al. 2021

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Value of Multidetector Computed Tomography in the Assessment of Achalasia Subtypes and Detection of Pulmonary and Thoracic Complications

et al. 2019

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Objective: To evaluate multidetector computed tomography (MDCT) findings in patients with achalasia, to assess its role in differentiating subtypes in detecting lung involvement and extra-esophageal thoracic complications. Subjects and Methods: This clinical retrospective study included 51 patients with manometrically confirmed achalasia who underwent chest X-ray and MDCT in diagnostic work-up. Esophageal wall thickness and morphology, luminal dilatation, lung changes, and extra-esophageal manifestations were analyzed on MDCT by 2 readers. Wilcoxon, Kruskal-Wallis and Mann-Whitney test were used for assessing the differences among the achalasia subtypes, and intra-class correlation coefficients (ICC) assessing the inter-observer agreement between the measurements of 2 readers. Results: Fourteen (27.5%) patients had achalasia subtype I, 21 (60.8%) had subtype II while 6 (11.8%) had subtype III. Esophageal wall thickness of the esophageal body (EB) and distal esophageal segment (DES) as well as nodular/lobulated appearance of DES were found significantly more often in subtype III (p = 0.024, p < 0.001, p = 0.009, respectively). Esophageal dilatation gradually decreased from subtype I to III (p = 0.006). Chest X-ray revealed lung changes in 9 (17%) and MDCT in 21 (41%) patients (p = 0.001), most frequently in subtype I, with predominance of ground-glass opacities. Tracheal/carinal compression was detected in 27 (52.9%) and left atrial compression in 17 (33.3%) patients. Excellent inter-observer agreement was observed in measuring the EB and DES wall thickness, and diameter of EB (ICC 0.829, 0.901, and 0.922). Conclusion: MDCT is a useful tool for detecting lung and extra-esophageal thoracic complications in patients with achalasia, and could be a valuable additional imaging modality in the differentiation of achalasia subtypes.

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Left Atrial Compression Secondary to Massive Esophageal Dilatation in a Patient With Idiopathic Achalasia

Abstract: Graphical abstract

Cited by 2 publications

References 16 publications

A Rare Cause of Left Atrium Compression

A Rare Cause of Left Atrium Compression

Value of Multidetector Computed Tomography in the Assessment of Achalasia Subtypes and Detection of Pulmonary and Thoracic Complications

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