Achalasia: a rare cause of stridor

A 56-year-old woman presented to the emergency department (ED) acutely stridorous. The patient was leaning forward, unable to speak and could not swallow. The patient was, however, able to communicate through gesturing and writing. She confirmed a prior history of untreated achalasia, and had eaten a large meal one hour prior to ED presentation. Physical examination (PE) revealed a woman in obvious respiratory distress. Vital signs included: temperature 36.4C, pulse 92 beats per minute, blood pressure 109/ 56 mmHg, respiratory rate 30 breaths per minute and a room air oxygen saturation of 100%. The head, ears, eyes, nose and throat examinations were unremarkable. The neck examination revealed an audible inspiratory stridor. Palpation of the neck did not identify a mass or thyromegaly, however the patient did have tenderness in the anterior neck. The remainder of the PE was unremarkable. Radiographs were obtained. A cardiothoracic surgery consultation was obtained. The insertion of a nasogastric tube (NGT) was attempted to decompress the esophageal dilatation.