S2268 Dysphagia Megalatriensis: A Modern Day Mimicker of Gastric Dysphagias

Abstract

Introduction: Cardiomegaly- induced dysphagia, also known as Dysphagia Megalatiensis had been previously reported to be secondary to Left Atrial enlargement. We are reporting an uncommon case where the dysphagia was induced by Left Ventricular enlargement. Case Description/Methods: The patient is a 59-year-old female with a past medical history of heart failure with reduced ejection fraction (EF) of 30%, who presented to the outpatient clinic with 3 months duration of dysphagia to solids and liquids. Her symptoms had started a few years prior to presentation and had worsened significantly in the past 3 months. She complained of regurgitation of undigested food associated with intermittent heartburn, not alleviated by antacids. Review of systems (ROS) was positive for recent lower extremity edema unremarkable otherwise. Laboratory workup was negative for anemia with normal biochemical and liver function tests. The patient was vitally stable with a physical remarkable for mild pitting edema of bilateral lower extremities with a normal abdominal exam. Barium esophagogram revealed narrowing of the lower esophagus and delay of barium emptying. Esophagogastroduodenoscopy showed an extrinsic compression in the mid esophageal area, with narrowed esophageal lumen of 25-30 cm from the incisors in the absence of fixed structures or strictures. Transthoracic echocardiogram (TTE) followed by nuclear medicine cardiac perfusion stress test diagnosed severe left ventricular dilatation with an EF of 25% highlighting this left ventricular dilatation as the primary etiology for this patient’s dysphagia (Figure). Discussion: This case highlights that achalasia could be the presentation of cardiomegaly and that left ventricular dilatation is a legitimate etiology that should always be considered in an outpatient setting. Dysphagia Megalatiensis is often a challenging diagnosis but when pretest probability is high a cardiac workup is warranted.Figure 1.: Mid-esophageal external compressor.