An unusual cause of thoracic inlet obstruction

Abstract

A rare complication of achalasia of the cardia is described which presented as partial asphyxia from tracheal compression at the thoracic inlet. A 65-year-old woman was referred as an emergency to The Westminster Hospital with a history of increasing difficulty in breathing associated with intermittent swelling of the neck. So dramatic were her symptoms that the referring physician considered her to be in danger of asphyxiating. He also observed that the severity of these attacks was directly proportional to the size of the swelling in the neck. Her past history centred around a diagnosis of achalasia of the cardia made at the age of 19, which had been managed in the subsequent 46 years by successive mercury balloon bouginage, followed by gastrotomy and manual dilation in 1938 and Heller's cardiomyotomy in 1948 and 1963. Dysphagia for solids had developed after the last operation and caused her to survive on a diet of liquids and semi-solid food.