case_images: PMC10403980_01
case_images: DWI axial MRI sequence demonstrating symmetrical hyperintensities of the periventricular region of the third ventricle. The hyperintense lesions are indicative of the edematous and high-water content nature of the lesions.. Abbreviations: DWI, diffusion-weighted imaging; MRI, magnetic resonance imaging.
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case_images: PMC10403980_01_10.1177_23247096231190628-fig1.jpg
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case_images: Her MRI in relation to her nutritional panel revealed hyperintensities of the bilateral walls of the third ventricle and mammillary bodies (Figures 1 and 2).
case_images: FLAIR axial MRI sequence demonstrating symmetrical hyperintensities of the periventricular region of the third ventricle. The hyperintense lesions are indicative of the edematous and high-water content nature of the lesions.. Abbreviations: FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
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case_images: PMC10403980_01_10.1177_23247096231190628-fig2.jpg
case_images: fig2-23247096231190628
case_images: Her MRI in relation to her nutritional panel revealed hyperintensities of the bilateral walls of the third ventricle and mammillary bodies (Figures 1 and 2).
case_images: Clouse plot: Demonstration of high-resolution normal manometry testing, time located on the x-axis and distance from nostril on the y-axis. Manometry testing utilizes 36 solid-state sensors for detection of pressure along the esophagus. The color-coded pressures demonstrated on the Clouse plot are indicative of intraluminal pressures, with elevated pressures demonstrated by red-maroon colors. The pressures, phase, and time plot assess the esophageal sphincter and primary peristalsis. Prior to initiation of swallowing, the upper esophageal sphincter (UES) and esophagogastric junction (EGJ) are high pressure zones. The objective metrics are incorporated into the Chicago Classification System for determination of pressures including integrated relaxation pressure (IRP), a reflection of the average function of the lower esophageal sphincter.
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case_images: PMC10403980_01_10.1177_23247096231190628-fig3.jpg
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case_images: High-resolution manometry demonstrated abnormal relaxation of the esophagogastric junction (EGJ), abnormal relaxation median supine integrative relaxation pressure (IRP) (46 mm Hg), IRB 70 mm Hg in upright position, hypertensive lower esophageal sphincer (LES), absence of normal peristalsis with pan-esophageal pressurization in all swallows, scattered jackhammer activity, and retrograde peristalsis and negligible upper esophageal sphincter (UES) tone (Figures 3 and 4).
case_images: Clouse plot: Manometry study respective to our patient with type II achalasia. According to the Chicago Classification System, type II achalasia is defined by an integrated relaxation pressure (IRP) above the upper limit of normal, 100% failed peristalsis, and over 20% pan-esophageal pressurization (PEP). The PEP reflects the compartmentalization of pressure from the upper esophageal sphincter (UES) to the lower esophageal sphincter (LES) at the threshold of the 30 mm Hg isobaric contour. This Clouse Plot for our patient demonstrated an IRP of 46 mm Hg, isobaric paraesophageal pressurization, and complete absence of normal peristalsis.
case_images: 10.1177_23247096231190628-fig4.jpg
case_images: PMC10403980_01_10.1177_23247096231190628-fig4.jpg
case_images: fig4-23247096231190628
case_images: High-resolution manometry demonstrated abnormal relaxation of the esophagogastric junction (EGJ), abnormal relaxation median supine integrative relaxation pressure (IRP) (46 mm Hg), IRB 70 mm Hg in upright position, hypertensive lower esophageal sphincer (LES), absence of normal peristalsis with pan-esophageal pressurization in all swallows, scattered jackhammer activity, and retrograde peristalsis and negligible upper esophageal sphincter (UES) tone (Figures 3 and 4).