Hindawi Publishing Corporation Case Reports in Otolaryngology Volume 2013, Article ID 368504, 3 pages http://dx.doi.org/10.1155/2013/368504 Case Report Idiopathic Oesophageal Dysmotility Disorder: Stridor Secondary to Megaesophagus B. G. Natesh, 1 N. Caton, 2 D. Kim, 1 and A. Shetty 1 1 Queen Alexandra Hospital, Southwick Hill Road, Portsmouth, Hampshire PO6 3LY, UK 2 ENT Department, St. Mary’s Hospital, Praed Street Paddington, London W2 1NY, UK Correspondence should be addressed to N. Caton; nadinecaton1@gmail.com Received 30 August 2013; Accepted 30 October 2013 Academic Editors: A. Gallo, M. Gupta, H.-S. Lin, K. Takano, and M. S. Timms Copyright © 2013 B. G. Natesh et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We present an interesting case of an elderly lady who presented with stridor caused by megaesophagus secondary to an acquired idiopathic dysmotility disorder. We discuss the aetiology and management of megaesophagus secondary to this condition and how it difers from megaesophagus secondary to achalasia. 1. Introduction Megaesophagus is commonly associated in patients with achalasia cardia. Tese patients can present with stridor and this is widely published in the literature. We present an inter- esting case of an elderly lady who was presented with stridor secondary to an acquired idiopathic dysmotility disorder. We discuss the aetiology and management of megaesophagus secondary to this condition. 2. Case Report A 94-year-old female was presented with a 24-hour history of rapidly increasing stridor associated with a difuse anterior neck swelling and chest pain radiating to her back. She had been experiencing hoarseness of voice for the past four months. She did not report any history of dysphagia or odynophagia. Her past medical history included a benign tumour of the sof palate, which was treated with radiother- apy during the late 1980’s. She is a nonsmoker. On examination in the emergency department, she had a difuse, frm anterior neck swelling that was nontender. Tere was obvious distension of the neck and upper anterior chest veins suggesting the possibility of a superior vena cava obstruction as a result of the neck swelling. Te patient was in extreme distress with an impending airway obstruction. A chest radiograph (Figure 1) was performed in the emergency department and demonstrated an unusual large air- flled swelling in the neck. It was evident that the patient was tiring and struggling to maintain adequate oxygenation on maximal oxygen therapy. Te patient was therefore directly transferred to theatre for further assessment and defnitive airway management. In theatre, with attendance of the anaes- thetic and ENT teams, a fexible nasoendoscopic examination demonstrated a smooth and difuse, noninfamed swelling of the posterior pharyngeal wall which was causing an acute airway obstruction. Vocal cord movements were normal but there was severe oedema of the supraglottic tissues, which further compromised the airway. A secure airway needed to be established so the patient underwent awake fbre-optic intubation, which proved to be difcult given the gross oedema of the upper airway. Given the difculty with intubation, a decision was agreed to perform an emergency tracheostomy under local anaes- thesia. Subsequent rigid pharyngoscopy demonstrated a compressible mass in the posterior pharyngeal wall, and oesophagoscopy revealed massive food impaction of the whole length of the oesophagus within a grossly dilated oesophagus. Te impacted food bolus had displaced the upper oesophagus by causing it to “slide” behind the pharynx to create the observed posterior pharyngeal wall swelling. Further, the food impaction had caused local venous con- gestion and secondary oedema of the upper airway mucosa compounding the airway obstruction. Food was evacuated up