Oesophageal 131I uptake in a patient with achalasia.

DESCRIPTION A54-year-old female patientwas referred to our hospital for a chest x-ray due to chest discomfort of 2 months duration. She had a history of thyroid cancer. The chest x-ray demonstrated a large posterior mediastinal mass with smooth borders, displacing the trachea anteriorly (figures 1 and 2). Because of her history of thyroid cancer, a I total body scan was ordered to exclude metastatic disease (figure 3). Marked I activity was identified within a dilated oesophagus. There were no other areas of an abnormal uptake to indicate loco-regional or a distant metastatic disease (figures 4 and 5). CT of the chestwas ordered after the nuclear medicine iodine scan. This confirmed diffuse marked oesophageal dilatation containing a large volume of fluid and debris, with a classic ‘bird's beak’ configuration at the oesophagogastric junction, pathognomonic of primary achalasia. A follow-up video swallow revealed marked stasis of the barium column within a dilated, sharply tapered distal oesophagus (‘bird's beak’ sign). Radioiodine accumulation in the oesophagus due to achalasia has been rarely reported. There are several postulatedmechanisms, but themost common is stasis and accumulation of radioiodine in an atonic oesophagus following ingestion of a I pill. Typically, there is rapid transit of radiotracer into the bowel, with little if any activity in the oesophagus.