Interesting image. Serendipitous diagnosis of achalasia cardia on a radionuclide study.

Achalasia cardia is a motility disorder, involving the distal esophagus, resulting in elevated lower esophageal sphincter pressure, increased intraesophageal pressure, incomplete relaxation of lower esophageal sphincter in response to deglutition and loss of esophageal peristalsis. It usually presents between third and fifth decades of life with the most common symptom of dysphagia. We present a case of middle-aged lady who complained of intermittent vomiting after meal and excessive postprandial sense of fullness in abdomen. It was suspected to be related to delayed gastric emptying. Therefore, a gastric emptying time study was requested. The solid bolus of radioactive meal was held up in the lower end of esophagus, thereby suggesting achalasia. Barium meal examination confirmed the diagnosis.