case_images: PMC11813637_01
case_images: Electrocardiogram done on admission, showing only sinus tachycardia. aVL: augmented vector left; aVR: augmented vector right; aVF: augmented vector foot
case_images: cureus-0017-00000077308-i01.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i01.jpg
case_images: FIG1
case_images: An electrocardiogram done in the emergency department earlier showed sinus tachycardia without ischemic changes (Figure 1).
case_images: Plain chest radiograph showing a convex widening of the right mediastinal border (solid arrows), with air-fluid level (open arrows) suggestive of a grossly dilated esophagus, and absent gastric bubble (*)
case_images: cureus-0017-00000077308-i02.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i02.jpg
case_images: FIG2
case_images: POCUS at the epigastrium level using the liver as acoustic window showing (a) dilated distal esophagus with fluid content located posterior to the liver. (b) Corresponding drawing illustration of the POCUS image. POCUS: point-of-care ultrasound; IVC: inferior vena cava; HV: hepatic vein. *Gastroesophageal junction.  Image credit: Figure 3b is an original image created by the author Vui H. Chong
case_images: cureus-0017-00000077308-i03.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i03.jpg
case_images: FIG3
case_images: This revealed a dilated structure located behind the posterior border of the liver (Figure 3), with fluid contents sloshing around with respirations and patient movements, consistent with a dilated esophagus.
case_images: POCUS at the cervical esophagus. (a) Transverse view showing a dilated cervical esophagus measuring 26.4 mm with reverberation artifacts due to air inside the esophagus with corresponding drawing illustration showing the structures. (b) Sagittal view of the scan showing a dilated esophagus up to the UES and the corresponding drawing illustration showing the structures. Reverberation artifacts due to air inside the esophagus highlighted by small white arrows and thickened esophageal wall (*). POCUS: point-of-care ultrasound; UES: upper esophageal sphincter. Image credit: The corresponding drawing illustrations are original images created by the author Vui H. Chong
case_images: cureus-0017-00000077308-i04.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i04.jpg
case_images: FIG4
case_images: POCUS examination at the neck level showed a dilated cervical esophagus up to the level of the upper esophageal sphincter (UES) in both transverse and sagittal views (Figure 4).
case_images: Coronal CT image showing a grossly dilated fluid-filled esophagus (*) extending up to the neck. CT: computed tomography
case_images: cureus-0017-00000077308-i05.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i05.jpg
case_images: FIG5
case_images: Upper gastrointestinal endoscopy showing a dilated esophagus with food residue and lower esophageal sphincter spasm, prior to balloon dilation. Gastroesophageal opening is indicated by an arrow
case_images: cureus-0017-00000077308-i06.jpg
case_images: PMC11813637_01_cureus-0017-00000077308-i06.jpg
case_images: FIG6
case_images: A copious amount of fluid and food debris were cleared before dilation (Figure 6).