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Chest radiograph of a 61-year-old man with a history of long-standing dysphagia and frequent vomiting.
At first glance, the image suggests cardiomegaly consequent to pericardial effusion or dilated myocardium. On closer inspection,however, the right “heart” border is somewhat irregular and ill-defined. A barium swallow (image below) showed that the abnormal “cardiac” configurationrepresented a dilated esophagus.
The medical literature appropriately indicates that the dilated esophagus in patients with achalasia can sometimes be mistaken onchest radiographs for mediastinal or pulmonary disease. This case demonstrates that a dilated esophagus can also mimic cardiomegaly.
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