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Fig. 2.21a-c. Achalasia. AP (a) and lateral (b) chest radiographs reveal an air-fluid level in the distended esophagus. c Delayed lateral chest radiograph. Barium fills the entire length of the esophagus, which tapers distally. There has been minimal flow of barium into the stomach

bubble is not visualized in cases with high grade obstruction. The esophagram is the initial diagnostic study, followed by esophageal manometry and endoscopy. Barium esophagram reveals a dilated esophagus that tapers smoothly distally to a "bird's beak". Occasionally, a leiomyoma may mimic the symptoms and radiographic appearance of achala-sia (Hussain et al. 2002).

sis. Those that lodge can cause severe complications within a short time after ingestion and must be removed endoscopically as soon as possible.

Complications of foreign body ingestion include perforation and abscess formation. Flexible endoscopy is the most common method for removal.

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