Achalasia cardia: an interesting variation as a large neck swelling

In this report we present a case of large neck swelling that turned out to be achalasia cardia, not a very common presentation of this disease. An elderly female presented with complain of progressive dysphagia, aspiration and regurgitation of food along with right sided neck swelling measuring 10x5 cm. It was associated with weight loss. X-ray chest depicted an unusually large mass in paramediastinal region parallel to right mediastinal border showing central lucencies. A CT scan of neck revealed a gross dilatation of cervical and thoracic oesophagus. Oesophagus enlargement was enormous to the extent that it could be palpated in the neck compressing airway. This presentation of large neck swelling turning out to be a huge dilatation of esophagus on CT, depicts one of the many interesting variations that this condition can present as.