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Thorax Online First, published on May 8, 2015 as 10.1136/thoraxjnl-2014-206615 Chest clinic

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An unusual case of respiratory arrest V Chew, J Azam, S Shah

Correspondence to Dr V Chew, Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire WF1 4DG, UK; [email protected] Received 26 March 2015 Accepted 4 April 2015

A 38-year-old non-smoker was found by paramedics holding on to a salbutamol inhaler. Examination showed generalised reduced air entry but no wheeze. She was initially treated as having an acute exacerbation of asthma with nebulisers and intravenous steroid. On arrival at A&E, the patient deteriorated further and went into respiratory arrest. She was intubated and ventilated. A chest X-ray (figure 1) was performed, which showed a right upper zone area of lucency and a CT thorax (figure 2) was reported as showing grossly dilated oesophagus containing food residue and marked compression of trachea below the endotracheal tube. A nasogastric tube was subsequently inserted and food residue was aspirated. An oesophago-gastro-duodenoscopy performed post extubation did not show any physical obstruction. The patient was subsequently referred to a tertiary centre for a myotomy.1

LEARNING POINT Megaoesophagus leading to tracheal compression is a rare manifestation of achalasia. A previous case report describes that the first case was documented in the 1950s and only 50 cases have been documented since then.

Figure 2 CT thorax showing dilated oesophagus with marked trachea compression. A major learning point in this case was the presumption of asthma. The patient had a known history of achalasia and no history of asthma. The inhaler that the patient was using actually belonged to her partner who gave a collateral history of increased chest discomfort and regurgitation particularly after a meal for the preceding week. This shows the importance of getting a background on a patient though it was noted that the patient was peri-arrest on arrival to A&E. Contributors VC (main guarantor) plan, conduct and co-reported with JA. SS proof read this article. Competing interests None declared. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.

To cite: Chew V, Azam J, Shah S. Thorax Published Online First: [ please include Day Month Year] doi:10.1136/thoraxjnl-2014206615

REFERENCE 1

Figure 1 lucency.

Chest X-ray showing right upper zone

Wen E, Susanto I. Acute respiratory failure secondary to achalasia. Proceedings of UCLA HealthCare, 2009;13. Published 18 Dec 2009. http://www.med.ucla.edu/modules/xfsection/article.php? articleid=426

Chew V, et al. Thorax 2015;0:1. doi:10.1136/thoraxjnl-2014-206615

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Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd (& BTS) under licence.

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Pinderfields General Hospital, Wakefield, West Yorkshire, UK

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An unusual case of respiratory arrest V Chew, J Azam and S Shah Thorax published online May 8, 2015

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