Pseudoachalasia in an Achalasia Patient: A Ticking Time Bomb

Abstract

The differential for dysphagia is broad, with dysphagia aortica being an incredibly rare cause of pseudoachalasia. In a patient with longstanding, refractory achalasia who presents with progressive dysphagia, Occam's Razor would suggest that the underlying cause remains achalasia itself. We present a case in which a patient with known achalasia developed concurrent pseudoachalasia due to dysphagia aortica. This case underscores the diligence of her gastroenterologist in identifying an unsuspected aortic aneurysm-an entity that the cardiothoracic surgery team deemed "a ticking time bomb." It is critical to always consider Hickam's dictum: Patients may have multiple diseases simultaneously.

Keywords: achalasia; aortic aneurysm; dysphagia; endoscopic ultrasound; pseudoachalasia.