RESUMO
ABSTRACT: Various factors leading to unexpected false-positive 131 I uptake have been extensively studied in patients with differentiated thyroid carcinoma. In this case, we present a patient who underwent achalasia surgery and subsequently exhibited abnormal 131 I uptake on SPECT/CT imaging. The patient was a known case of papillary thyroid carcinoma that suggested to 131 I therapy. 131 I SPECT/CT showed linear increased activity in the distended esophagus.
Assuntos
Acalasia Esofágica , Radioisótopos do Iodo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Humanos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Acalasia Esofágica/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Feminino , Pessoa de Meia-Idade , Masculino , Tomografia Computadorizada por Raios XRESUMO
We present an unusual case of achalasia presenting with dyspnoea and persistent cough. These symptoms persisted for months, leading to the patient undergoing a chest X-ray by her general practitioner which showed right basal consolidation and a density extending along the right mediastinum. CT scan was done which revealed megaoesophagus with a diameter of 7 cm causing tracheal compression, as well as right basal consolidation, consistent with aspiration. Further history revealed 6-month history of progressive swallowing difficulty, retrosternal chest pain and shortness of breath which worsened when eating solid foods. After thorough workup, a diagnosis of idiopathic achalasia (type II) was made. She was treated with laparoscopic Heller cardiomyotomy and Dor fundoplication with significant improvement at follow-up. Dyspnoea and respiratory symptoms are unusual presenting symptoms, suggesting a need to consider achalasia in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis and intervention prior to oesophageal failure.
Assuntos
Acalasia Esofágica , Laparoscopia , Feminino , Humanos , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/diagnóstico por imagem , Fundoplicatura , Dispneia/cirurgia , Tosse/complicações , Resultado do TratamentoRESUMO
Introducción: La manometría esofágica de alta resolución es la prueba ideal para el diagnóstico de la acalasia y muestra la presencia de ondas terciarias o aperistalsis y el aumento de presión, con ausencia de relajación, del esfínter esofágico inferior. Objetivo: Evaluar la utilidad de la manometría esofágica de alta resolución en el diagnóstico y clasificación de la acalasia esofágica. Métodos: Se realizó una investigación descriptiva, trasversal, en el Centro Nacional de Cirugía de Mínimo Acceso entre octubre del 2018 y diciembre del 2019, en 46 pacientes con diagnóstico de acalasia esofágica. Se excluyeron aquellos con cirugía previa del esófago. Las variables incluidas fueron: edad, sexo, tiempo de evolución, síntomas y hallazgos manométricos. Para el análisis de las variables cuantitativas se emplearon medidas de tendencia central, media y de dispersión, la desviación estándar. Las frecuencias y proporciones fueron utilizadas para describir las variables cualitativas. Resultados: Predominó la acalasia tipo II, en el sexo femenino (57 por ciento). La disfagia fue el síntoma más frecuente (84, 76 y 100 por ciento en los tipos I, II y III, respectivamente). El 70 por ciento de los casos presentó más de un año de evolución de los síntomas. La media de la presión de relajación integrada estuvo por encima de 21 mmHg independientemente del tipo. No se encontraron pacientes con subtipos de la acalasia tipo III. Conclusiones: La manometría esofágica de alta resolución es útil para el diagnóstico y clasificación de la acalasia esofágica(AU)
Introduction: High-resolution esophageal manometry is the ideal test for the diagnosis of achalasia and shows the presence of tertiary waves or aperistalsis and increased pressure, in the absence of relaxation, of the lower esophageal sphincter. Objective: To assess the usefulness of high-resolution esophageal manometry in the diagnosis and classification of esophageal achalasia. Methods: A descriptive, cross-sectional investigation was carried out at the National Center for Minimal Access Surgery, between October 2018 and December 2019, in 46 patients with a diagnosis of esophageal achalasia. Those with previous esophageal surgery were excluded. The variables included were: age, sex, time of evolution, symptoms and manometric findings. For the analysis of the results, the percentage and measures of central tendency (arithmetic mean and standard deviation) were used. Results: Type II achalasia predominated in females (57 percent). Dysphagia was the most frequent symptom (84, 76, and 100 percent in types I, II, and III, respectively). 70 percent of the cases presented more than one year of evolution of the symptoms. Regarding the high-resolution manometry parameters, it was observed that regardless of the type, the mean integrated relaxation pressure was above 21 mmHg. No patients with type III achalasia subtypes were found. Conclusions: High-resolution esophageal manometry is useful for the diagnosis and classification of esophageal acalasia(AU)
Assuntos
Humanos , Transtornos de Deglutição , Acalasia Esofágica/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais , Manometria/métodosRESUMO
Pseudoacalasia se manifesta de forma semelhante à acalasia do esfíncter esofágico inferior (EEI). Corresponde a 2,4 a 4% dos casos que simulam acalasia 1 . Estima-se que cerca de 50% dos casos de pseudoacalasia correspondam a malignidade primária do esôfago e da junção gastroesofágica e 18% a malignidades secundárias como doença metastática 1,2 . Etiologias benignas também estão descritas. No presente trabalho apresentamos um caso de pseudoacalasia com ênfase nos aspectos radiológicos. Revisamos também aspectos clínicos e radiológicos que podem auxiliar no diagnóstico diferencial entre acalasia e pseudoacalasia. (AU)
Pseudoachalasia is a condition that mimics idiopathic achalasia of the lower esophageal sphincter. It accounts for 2.4 to 4% of patients presenting with achalasia-like symptoms. It is estimated that about 50% of cases of pseudoachalasia correspond to primary malignancies of the esophagus and the esophagogastric junction and 18% to secondary malignancies such as metastases 1,2 . Benign causes are also described. In this report we emphasize radiological findings of a case of pseudoachalasia. We also review clinical and radiological aspects that might be auxiliary in the differential diagnosis between achalasia and pseudoachalasia. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Acalasia Esofágica/diagnóstico por imagemRESUMO
La acalasia en el embarazo es una condición infrecuente, pobremente conocida y su manejo no esta claramente definido. Las repercusiones sobre el estado nutricional de los pacientes con esta entidad son graves y en una gestante tienen implicaciones serias para el curso de la gestación, con riesgo elevado de restricción del crecimiento intrauterino, parto pretérmino e incluso pérdida fetal; existen síntomas que pueden confundirse con hiperémesis gravídica retrasando el diagnóstico. Dentro de las opciones terapéuticas está el manejo médico, endoscópico e intervenciones quirúrgicas; para decidir cual es tratamiento adecuado se debe tener en cuenta la severidad, edad gestacional y condicien clasificaci de teratogenicidad conocido siendo su uso bienestar del binomioones del paciente, dentro del espectro mencionado en el manejo se incluyen los calcioantagonistas y nitratos, estos con restricciones en el embarazo, además toxina botulínica, dilatación neumática endoscópica, miotomía laparoscópica de Heller y recientemente el POEM; estas últimas con riesgo elevado de complicaciones. En el embarazo existe poca evidencia en la literatura y alrededor de 40 casos reportados, algunos con complicaciones como perdida fetal y muerte materna. Presentamos nuestra experiencia en el Hospital Universitario San Ignacio, Bogotá, Colombia de una mujer de 26 años de edad con diagnóstico de acalasia tipo 2 de novo durante el primer trimestre de gestación, cuadro clínico de disfagia severa asociado a desnutrición, a quien el manejo oportuno con soporte nutricional enteral con sonda nasogástrica para lograr repleción del índice de masa corporal (IMC) y luego de esto manejo endoscópico con dilatación con balón. Permitió llevar con éxito a término la gestación sin efectos adversos sobre la madre o el feto, con evolución adecuada y tolerancia a vía oral sin disfagia. Consideramos que es importante el soporte nutricional previo a la toma de conducta con este tipo paciente, además que el manejo endoscópico con dilatación puede ser seguro y efectivo a mediano plazo para el manejo de acalasia en embarazo.
Achalasia in pregnancy is an infrequent, poorly understood condition and its treatment is not clearly defined. The repercussions on the patients nutritional status are serious and in a pregnant woman have serious implications for the course of gestation, with high risk of intrauterine growth restriction, preterm delivery and even fetal loss; there are symptoms that can be confused with hyperemesis gravidarum delaying the diagnosis. The therapeutic options are medical treatment, endoscopic and surgical interventions; to decide what is the best treatment, we should be taken into account the severity, gestational age and patient conditions. Within the spectrum mentioned in the management include calcium antagonists and nitrates, however these have restrictions in pregnancy, another options are botulinum toxin, endoscopic pneumatic dilation, laparoscopic Heller myotomy and recently POEM. In pregnancy there is a few evidence in the literature and in this moment there are about 40 reported cases, some with complications such as fetal loss and maternal death. We present our experience at the San Ignacio University Hospital in Bogotá, Colombia, with a 26-year-old woman with a novo diagnosis of achalasia type II during the first trimester of pregnancy, with a clinical history of severe dysphagia associated with malnutrition. She was management with enteral nutrition support with nasogastric tube to achieve repletion of the body mass index (BMI) and after that, she had a endoscopic management with Rigiflex balloon dilation. It allowed to successfully carry out pregnancy without adverse effects on the mother or the fetus, with adequate evolution and oral tolerance without dysphagia. We consider that nutritional support is important prior to taking a desicion with this type of patient, in addition that endoscopic management with balloon dilation can be safe and effective for the management of achalasia in pregnancy.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/terapia , Acalasia Esofágica/terapia , Esofagoscopia/métodos , Dilatação/métodos , Transtornos de Deglutição/etiologia , Acalasia Esofágica/diagnóstico por imagem , Índice de Massa Corporal , Nutrição Enteral , Terapia Combinada , Desnutrição/complicações , Intubação Gastrointestinal , ManometriaRESUMO
Abstract INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS: A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS: Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.
Assuntos
Humanos , Masculino , Feminino , Radiografia/métodos , Acalasia Esofágica/etiologia , Acalasia Esofágica/diagnóstico por imagem , Esofagoscopia/métodos , Doença de Chagas/complicações , Valores de Referência , Índice de Gravidade de Doença , Acalasia Esofágica/patologia , Estudos Transversais , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pessoa de Meia-IdadeRESUMO
ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.
RESUMO A manometria de alta resolução mudou vários paradigmas da motilidade digestiva. A Classificação de Chicago, na versão 3.0, definiu critérios manométricos para as doenças da motilidade esofagiana. O presente artigo é um atlas das dismotilidades descritas. Tipos de acalásia, obstrução ao nível da junção esofagogástrica, contrações ausentes, espasmo esofagiano distal, esôfago hipercontrátil, motilidade esofagiana ineficaz e peristalse fragmentada são mostradas em traçados de manometria de alta resolução.
Assuntos
Humanos , Transtornos da Motilidade Esofágica/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/instrumentação , Transtornos da Motilidade Esofágica/classificação , Acalasia Esofágica/classificação , Acalasia Esofágica/diagnóstico por imagem , Manometria/instrumentaçãoRESUMO
Achalasia is a rare disease in children. It is an idiopathic disease characterized by loss of normal peristalsis in the distal esophagus and the inability of the lower esophageal sphincter (LES) to relax properly. It presents with dysphagia and weight loss. The imaging study, particularly the study of the esophagus, stomach, duodenum with barium contrast medium, is the diagnostic test of choice, which in 95% of cases enables a diagnosis. There are various therapeutic options including pneumatic dilation (PD), botulinum toxin injection (BT) and surgery, with the latter giving the best long-term results, the access path is mainly laparoscopic. We report the case of a pediatric patient, evaluated in our department, diagnosed with achalasia.
La acalasia es una enfermedad infrecuente en población pediátrica. Es una enfermedad de causa desconocida que se caracteriza por la pérdida de la peristalsis normal del esófago distal y de la incapacidad del esfínter esofágico inferior de relajarse adecuadamente. El estudio con imágenes, particularmente el estudio del esófago, estómago, duodeno con medio de contraste baritado, es el test de elección, el cual en un 95% de los casos nos otorga un diagnóstico de certeza. Existen diversas opciones terapéuticas, entre ellas la dilatación neumática, la toxina botulínica y la cirugía, siendo esta última la con mejores resultados a largo plazo, la vía de acceso es principalmente laparoscópica. Presentamos el caso de un paciente pediátrico, evaluado en nuestro departamento, diagnosticado de acalasia.