The document discusses several medical conditions. It provides descriptions of myelomeningocele, congenital megaureter, plasma cell mastitis, granuloma abscess, BI-RADS category 5 corona sign, adhesive capsulitis or frozen shoulder, fibrous cortical defect, Brodie's abscess, chronic osteomyelitis, simple bone cyst, ossification of the posterior longitudinal ligament, osteonecrosis/avascular necrosis including Perthes disease, non-ossifying fibroma, periosteal osteosarcoma, Graves' ophthalmopathy, sequestered disc, suprasellar giant aneurysm, nasopharyngeal tumor stage 4, Fahr disease, agenesis of the corpus

1. Lisan mandiri
By FM

2. MYELOMENINGOCELE
MD
Defect spinal cord setinggi corpus vt L
Herniasi sac berisi cairan densitas LCS dan
nerve fiber

3. Megaureter congenital
Tipe
1. Obtruktif, distal adynamic segment with proximal
dilatation and is a common cause of obstructive
uropathy in children
2. Reflux, bnormal vesicoureteric junction, which
impedes the normal anti-reflux mechanisms
3. Non reflux
ureter is enlarged (>7 mm)
In obstructive primary megaureter the ureter tapers to
a short segment of normal caliber or narrowed distal
ureter, usually just above the vesicoureteric junction
(VUJ). The distal ureter above this narrowed segment is
most dilated

4. Plasma cell mastitis
HR
• benign breast condition which
represents calcification of inspissated
secretions in or immediately adjacent
to ectatic benign ducts
• Calcifications are thick, linear, rod-like
or cigar-shaped. Calcifications can be
up to 10 mm long. They tend to be
bilateral, often symmetrical in
distribution and oriented with long
axes pointing toward the nipple1.
Branching may sometimes be seen.
• Popcorn calcification mrpkan tanda
hyalinisasi dari fibroadenoma

5. Granuloma abcess
• breast inflammatory disease of unknown origin that can clinically
mimic carcinoma of the breast.
• The most common mammographic appearance of the lesion is an
asymmetrically increased density, which is not characteristic for this entity
• USG  a mass-like appearance, tubular/nodular hypoechoic structures and
focal decreased parenchymal echogenicity with acoustic shadowing.

6. Birads 5-corona sign

7. Adhesive capsulitis ( frozen shoulder )
• thickening and contraction of the shoulder joint capsule and
surrounding synovium.
• 3 stage :
- freezing: painful stage, as the symptoms progress, pain worsens
and both active and passive range of motion (ROM) becomes more
restricted
- frozen: transitional stage, pain at the end of the range of motion,
arm movement may be limited, causing muscular disuse
- thawing stage, the range of motion starts to improve
Dua type :
1. primary or idiopathic absence of preceding trauma
2. secondary  major or minor repetitive trauma, shoulder or
thoracic surgery, endocrine, e.g. diabetes, hyperthyroidism ,
rheumatological conditions

9. •normal inferior glenohumeral ligament measures <4 mm and is best
seen on coronal oblique images at the mid glenoid level; in adhesive
capsulitis, the axillary recess may show thickening ≥1.3 cm
•joint capsule thickening 2
• anterior capsule thickness >3.5 mm and abnormal
hyperintensity 14
•abnormal soft tissue thickening within the rotator interval with signal
alteration
•abnormal soft tissue encasing the biceps anchor
•variable enhancement of the capsule and synovium within the
axillary recess and rotator interval
Other MR arthrography features include:
•thickening of the coracohumeral ligament (CHL) 4
•subcoracoid triangle sign

10. Olecranon bursitis • inflammation of the olecranon bursa.
• The olecranon bursa is a subcutaneous sac that overlies the olecranon
process and contains a small amount of fluid to prevent against injury
of subcutaneous tissue and skin from the uncovered bony olecranon
• Lateral radiograph of the elbow reveals soft tissue swelling superficial
to the olecranon
Ultrasound  fluid collection in the olecranon bursa, features of synovial
proliferation and/or hyperemia
CT  fluid density at the subcutaneous tissue superficial to the elbow
MRI
Bursal fluid collection has the following features:
T1: hypointense
T2: mainly hyperintense
C+ (Gd): enhancement of bursal margins

11. Fibrous cortical defect
• benign bony lesions and are a type
of fibroxanthoma, histologically identical to the
larger non-ossifying fibroma (NOF)
• typically occur in children
• They typically occur in the metaphysis or
diametaphyseal junction and appear as small (<2-
3 cm) lucent defects within the cortex that over
time become sclerotic as they heal. They are
typically located in the distal femur or proximal
or distal tibia. Importantly, there is no associated
soft tissue mass
Plain radiograph and CT
lucent intracortical defects
outlined by a thin rim of sclerosis
no involvement of the underlying medullary cavity
no periosteal reaction

12. Abses Brodie • intraosseous abscess related to a focus of subacute pyogenic osteomyelitis
It has a predilection for ends (metaphysis) of tubular bones:
proximal/distal tibial metaphysis (most common)
Plain radiograph
 lytic lesion often in an oval configuration that is oriented along the long axis of
the bone
 surrounded by a thick dense rim of reactive sclerosis
 lucent tortuous channel extending toward growth plate prior to physeal closure
(pathognomonic)
 periosteal new-bone formation +/- adjacent soft-tissue swelling
CT
 central intramedullary hypodense cystic lesion with thick rim ossification
 extensive thick well-circumscribed periosteal reaction and bone sclerosis
around the lesion could be seen
MRI
The “penumbra sign” on magnetic resonance (MR) imaging is useful for
discriminating subacute osteomyelitis from other bone lesions. The penumbra sign
is a rim lining of an abscess cavity with higher signal intensity than that of the
main abscess on T1-weighted images with strongly and rapidly enhance after
contrast.

13. OM kronik
• a form of osteomyelitis and is a progressive inflammatory process
resulting in bone destruction and sequestrum formation
• It is a result of osteonecrosis caused by disruption of intraosseous
and periosteal blood supply during the acute stage of the disease.
A dead infected bone fragment becomes separated from viable
bone (known as a sequestrum). Infective agents within the
devascularised sequestrum become protected from antibiotics and
the endogenous immune response, forming a nidus for chronic
infection
• CT may provide information regarding the presence of sequestra,
cloaca, cortical destruction and the thickness of the involucrum.

14. Simple bone cyst
• Unicameral bone cyst
• common benign non-neoplastic lucent bony lesions that are seen mainly
in childhood
• When uncomplicated by fracture the cysts contain clear serosanguineous
fluid surrounded by a fibrous membranous lining. It is thought to arise as
a defect during bone growth which fills with fluid, resulting in expansion
and thinning of the overlying bone.
• They are typically intramedullary and are most frequently found in the
metaphysis of long bones, abutting the growth plate
• UBCs are well defined geographic lucent lesions with a narrow zone of
transition, mostly seen in skeletally immature patients, which are
centrally located and show a sclerotic margin in the majority of cases
with no periosteal reaction or soft tissue component. They sometimes
expand the bone with thinning of the endosteum without any breach of
the cortex unless there is a pathologic fracture
• If there is fracture through this lesion a dependent bony fragment may
be seen, and this is known as the fallen fragment sign.

15. OPLL Ossification of the posterior longitudinal
ligament
Stages of spinal cord damage by OPLL
stage 0: normal or mild compression of the
anterior horn without neuronal loss
stage 1: mild compression of the anterior horn
with partial neuronal loss
stage 2: marked deformity of anterior horn;
severe neuronal loss
stage 3: severe spinal cord damage
Types of OPLL
type 1: continuous (ossification of several
vertebral segments)
type 2: segmental (several segments are
affected, ossification is disrupted)
type 3: mixed (mix of types 1 and 2)
type 4: localized (circumscribed, only one or
two segments)

16. Osteonecrosis /AVN
Leg calve perthes
There is ill-defined mixed sclerotic and lytic lesion of the femoral
head. Additional cortical collapse of the superior aspect of the
femoral head is noted with a linear area of lucency below it
(crescent sign), measuring around 20mm. No evidence of secondary
degenerative changes.
MRI
T1: usually the initial specific findings are areas of low signal
representing edema, which can be bordered by a hyperintense line
which represents blood products
T2: may show a second hyperintense inner line between normal
marrow and ischemic marrow. This appearance is highly specific for
AVN hip and known as "double line sign“, consists of an inner bright
T2 line representing granulation tissue and surrounding dark zones
representing adjacent sclerotic bone

18. NOF
• type of non-neoplastic fibrous bone lesion and are a larger
version (>3 cm) of a fibrous cortical defect
• NOFs are typically a multiloculated lucent lesion with a
sclerotic rim. They are located eccentrically in the
metaphysis, adjacent to the physis. As the patient ages,
they seem to migrate away from the physis . They have no
associated periosteal reaction, cortical breach or
associated soft tissue mass.

19. Periosteal OSA
• form of surface osteosarcoma.
• arise from the inner germinative layer of periosteum
• Cytologic grade of this tumor is higher than parosteal
osteosarcoma and lower than conventional osteosarcomas
 broad-based surface soft-tissue mass causing extrinsic
erosion of thickened underlying diaphyseal cortex and
perpendicular periosteal reaction extending into the soft-tissue
component:
predominantly chondroid matrix , a periosteal
reaction common, as sunburst pattern (radiating from bone
surface) or a Codman triangle

20. Grave’s opthalmopathy
SM
• Thyroid-associated orbitopathy (or thyroid-associated
ophthalmopathy)
• bilateral and symmetrical enlargement of the extraocular muscle
bellies. The typical distribution is inferior rectus > medial rectus >
superior rectus, with sparing of their tendinous insertions-- coke
bottle' in nature (Coca-Cola bottle sign)
• The muscles are infiltrated with inflammatory cells (lymphocytes,
macrophages, plasma cells, and eosinophils), and increased
mucopolysaccharide deposition. In long-standing cases, increased
collagen deposition leads to fibrosis
The extraocular muscles are involved in a predictable fashion (I'M
SLOW mnemonic) : inferior rectus, medial rectus, superior rectus,
lateral rectus, obliques
Increase in orbital fat volume is a result of venous congestion from
the compression of the superior ophthalmic vein by the enlarged
muscles and/or intrinsic adipose inflammation increase in retro-
ocular orbital fat
exopthlamus

21. Sequestered disc
free disc fragment, corresponds to extruded disc material
that has no continuity with the parent disc and is displaced
away from the site of extrusion
2.5 cm fragment of sequestered L5/S1 disc, lying at the
level of the disc space and extending caudally to the
S1/S2 disc level. This occupies the majority of the spinal
canal with severe compression of the thecal sac and the
distal cauda equina. The right S1 descending nerve root is
compressed in the lateral recess.
Insignificant diffuse disc bulge at L4/L5.

22. Suprasellar giant aneurysma from ACA/Acom
• Non contrast axial images through the brain demonstrate
a large peripherally calcified mass in the suprasellar
region. It is hyperdense.
• CTA of the circle of Willis demonstrates a giant
peripherally calcified ACA/Acom aneurysm.

23. Tumor nasofaring stage 4

25. Fahr disease
• bilateral striatopallidodentate calcinosis, is characterized by
abnormal vascular calcium deposition, particularly simetris in
the basal ganglia, cerebellar dentate nuclei, and white matter, with
subsequent atrophy.
• globus pallidus affected first
• It can be either primary (usually autosomal dominant) or secondary
to a large number of underlying illnesses or metabolic disturbances
• Fahr disease is characterized by deposition of calcium in the walls
of the capillaries and larger arteries and veins. Other compounds,
such as mucopolysaccharides, and elements,
including magnesium, zinc, aluminum, and iron, have also been
found deposited in the vessels.

26. Agenesis CC • absent cingulate sulcus with the medial
hemispheric sulci seen reaching the third
ventricle in a radial fashion
• dilated high riding third ventricle
• parallel configuration of the lateral ventricles
• On axial views, the ventricles appear similar to
a racing car, and in coronal views, they appear
similar to a viking helmet or a moose head.
• It may be complete, partial, or atypical:
- with complete agenesis, the corpus callosum is
totally absent
- with partial agenesis (hypoplasia), the anterior
portion (posterior genu and anterior body) is
formed, but the posterior portion (posterior body
and splenium) is not. The rostrum and the
anterior/inferior genu are also not formed
• widely separated bodies of the lateral ventricles
and midline CSF Cleft.
• Disproportionately dilated occipital horns
(colpocephaly) without any periventricular CSF
seepage.

27. Sturge weber syndrome • a phakomatosis characterized by facial port wine
stains/ congenital facial cutaneous
hemangioma/facial nevus flammeus and pial
angiomas
• usually involves the ophthalmic division (V1) of
the trigeminal nerve
Plain radiograph
Skull x-rays  gyriform calcification of the subcortical
white matter
CT
 tram-track sign of cortical and subcortical
calcification
 calvarial and regional sinus enlargement
 ipsilateral choroid plexus may be enlarged
 orbital choroidal hemangiomas
 asymmetric cavernous sinus enlargement
MRI , T1 C+ (Gd) prominent leptomeningeal
enhancement in affected area (due to congested
internal cerebral veins, a manifestation of the so-called
'pial angiomatosis', resulting in venous congestive
ischemia with infarction and obliteration of cerebral
parenchyma)

29. creutzfeldt-jakob disease
• a spongiform encephalopathy that results in a
rapidly progressive dementia
T2: hyperintensity basal ganglia (putamen and caudate)
thalamus (see hockey stick sign and pulvinar sign)
cortex: most common early manifestation
white matter
These lesions show diffusion restriction on DWI/ADC
sequences
The hockey stick sign  hyperintense signal involving
the pulvinar and dorsomedial thalamic nuclei bilaterally
on FLAIR

30. Craniopharyngioma
• arise in the sellar/suprasellar region
• There are two histological
subtypes, adamantinomatous ( children
) and papillary ( adult )
• Kalsifikasi sering pada yg tipe adamantinoma dan
multiple cystic lesions
• distorting the optic chiasm or compressing
the midbrain with resulting obstructive
hydrocephalus.
• MR angiography: may show displacement of the
A1 segment of the anterior cerebral artery (ACA)

31. Spinal lipoma + hidrosyringomyelia
• Intradural lipomas may
occur anywhere in the
spinal canal. In adults
they are most commonly
found in the thoracic
region, whereas in
children the cervical
spine appears to be the
most common site
• They usually occur along
the dorsal midline of the
spinal cord. The spinal
cord is flattened
ventrally.

32. Cholesteatoma • epidermoid cyst and are composed of desquamated keratinizing
stratified squamous epithelium forming a mass.
• The pars flaccida cholesteatoma originates in Prussak space and
usually extends posteriorly, while the pars tensa cholesteatoma
originates in the posterior mesotympanum and tends to extend
posteromedially.

33. DAI
• traumatic axonal injury (TAI), is a severe form
of traumatic brain injury due to shearing forces
• several small regions of susceptibility artifact at the
grey-white matter junction, in the corpus
callosum, and in more severe cases in the brainstem,
surrounded by FLAIR hyperintensity.
• Staging
1. grade I: involves grey-white matter interface, most
commonly: parasagittal regions of frontal lobes,
periventricular temporal lobes
2. grade II: involves corpus callosum in addition to grade
I locations
3. grade III: involves brainstem in addition to grade I and
II locations

34. Cerebral amyloid angiopathy
• cerebrovascular disorder caused by the accumulation of cerebral
amyloid-β (Aβ) in the tunica media and adventitia of
leptomeningeal and cortical vessels of the brain
• Cerebral amyloid angiopathy can be divided into sporadic
(spontaneous) and familial forms.
cerebral microhemorrhage defined as 2-10 millimeter, round or
ovoid areas of hemorrhage, and tend to be corticosubcortical (grey-
white matter junction) in distribution, but can also be in the
cerebellum
tend to spare the basal ganglia and pons (cf. hypertensive
microhemorrhages)
MRI: only seen on T2* sequences (GRE, echo-planar, SWI) as
regions of low-signal blooming artifact , not seen on
conventional T1 and T2/FLAIR sequence

35. Neurocysticercosis
vs toxoplasmosis
CNS infection with the pork tapeworm Taenia solium
4 stage Escobar :
Vesicular
cyst with dot sign
CSF density/intensity
hyperintense scolex on T1 can sometimes be seen
no enhancement is typical, although very faint enhancement of the wall and
enhancement of the scolex may be seen
Colloidal vesicular
cyst fluid becomes turbid
CT: hyperattenuating to CSF
MRI T1: hyperintense to CSF 2
surrounding edema
cyst and the wall become thickened and brightly enhances
scolex can often still be seen as an eccentric focus of enhancement
Granular nodular : edema decreases, cyst retracts
Nodular calcified
end-stage quiescent calcified cyst remnant
no edema
no enhancement on CT
signal drop out on T2 and T2* sequences
some intrinsic high T1 signal may be present
long term enhancement may be evident on MRI and may predict ongoing
seizures

36. • opportunistic infection caused by the parasite Toxoplasma
gondii
MRI
T1: isointense or hypointense
T2 : hyperintense to isointense
hyperintense: thought to represent necrotizing
encephalitis
isointense: thought to represent organizing abscess
concentric alternating zone of hypo/hyper/isointense signal
also known as 'concentric target sign' lesions are
surrounded by perilesional edema
T1 C+ (Gd): ring enhancement or nodular enhancement. For this
pathology is also typically еccentric target sign on post-contrast
images

37. Subdural empyema
• a type of intracranial infection characterized by a suppurative collection between
the dura mater and arachnoid mater. It is commonly seen as a complication
of sinusitis, otitis, mastoiditis, or surgical intervention.
• subdural collection, crescentic in shape, with marked meningeal enhancement
and, on MRI, typically demonstrates restricted diffusion
Two mechanisms of spread :
1.direct extension
2.indirect: secondary to thrombophlebitis, the most common cause of spread

38. Esthesioneuroblastoma (Olfactory neuroblastoma)
• soft tissue hypoattenuating mass in the right /left ethmoid air
cells that extends through the lamina papyracea to the
right/left orbits abutting the medial rectus muscle, and also
extends intracranially through the right cribriform plate. No
intraconal extension is identified.
• heterogeneous contrast enhancement.
• soft tissue mass in the superior olfactory recess involving the
anterior and middle ethmoid air cells on one side and
extending through the cribriform plate into the anterior cranial
fossa.
- olfactory neuroepithelioma: rare and
indistinguishable on imaging
- olfactory groove
meningioma/haemangiopericytoma: especially if
superior extension
- sinonasal carcinoma (including SCC, minor
salivary gland adenocarcinoma): may appear
identical, older patients. lack peritumoural cysts
- Rhabdomyosarcoma
- melanoma metastases
- Lymphoma
- nasopharyngeal carcinoma: epicentre more
posteriorly located, older patients
- Chordoma: more posteriorly located, high T2
signal
- pituitary macroadenoma: more posteriorly
located
- juvenile nasopharyngeal angiofibroma: almost
exclusively in males, younger

39. Frontal lobe ensefalomalasia
• softening or loss of brain parenchyma with or without surrounding gliosis, as a
late manifestation of injury.
• the end result of liquefactive necrosis of brain parenchyma following insult,
usually occurring after cerebral ischemia, cerebral infection, hemorrhage,
traumatic brain injury, surgery or other insults. It is not synonymous with gliosis,
which is the proliferation of glial cells in response to injury.
CT
 region of hypoattenuation
 volume loss
 can occur anywhere however has characteristic locations are
anteroinferior frontal and temporal lobes
MRI  Follows CSF signal on all sequences.

40. Dural AVF
• heterogeneous collection of conditions that
share arteriovenous shunts from dural
vessels
• transverse/sigmoid sinusmost common
CT angiography :
 abnormally enlarged and tortuous vessels in
the subarachnoid space, corresponding to
dilated cortical vein
 an enlarged external carotid artery or
enlarged transosseous vessels
 abnormal dural venous sinuses including
arterialization of contrast phase in the
affected sinus due to arteriovenous
shunting

41. Late subacute hemorrhage

42. porencephaly • rare congenital disorder
• cystic degeneration and encephalomalacia
• communicates into internal (communicating with the
ventricle) or external (communicating with the
subarachnoid space)
• CT intracranial cyst which has a well-defined border
and central attenuation the same as CSF. There is usually
no mass effect on the adjacent parenchyma, although
occasionally enlarging cysts do result in local mass effect.
There is no enhancement with contrast and no solid
component.
• MRI  The content of the cyst follows CSF signal on all
sequences:
T1: low signal intensity
T2: high signal intensity
FLAIR: suppression of fluid signal intensity
DWI: no restricted diffusion

43. Stricture urethra, urethritis, batu urethra
TY

44. Ruptur ginjal grade 5

45. Diverticulosis VU
• outpouching from the bladder wall, whereby mucosa herniates
through the bladder wall. It may be solitary or multiple
• Diverticula may be congenital (primary) ex. Hutch diverticel or
acquired (secondary)
• Bladder is usually trabeculated

46. Open lip schizencephaly
• cortical malformation that manifests as a grey matter lined cleft
extending from the ependyma to the pia mater.
• the result of abnormal neuronal migration
• The grey matter that lines the cleft is abnormal, usually
representing polymicrogyria.
open lip
the cleft walls are separated and filled with CSF
most common form in bilateral cases
closed lip
the cleft walls are in apposition
most common form in unilateral cases
Most often the cleft involves the posterior frontal or parietal lobes
(70%)
MRI
closed-lip (type I): seen as nipple-like out-pouching at the ependymal
surface
open-lip (type II): heterotopic grey matter-lined CSF cleft seen extending
from the ventricular to the cortical surface

47. Closed lip schizencephaly

48. Microcolon
• jejunal and ileal atresia
• total colonic aganglionosis
• meconium ileus

49. Pneumonia TB
• patchy areas of consolidation or even lobar consolidation
• Cavitation is uncommon in primary TB
• the infection becomes localized and a caseating granuloma forms (tuberculoma)
which usually eventually calcifies and is then known as a Ghon lesion
• ipsilateral hilar and contiguous mediastinal (paratracheal) lymphadenopathy, usually
right-sided, typically have low-density centers with rim enhancement on CT
• Pleural effusions are more frequent in adult
• When a calcified node and a Ghon lesion are present, the combination is known as
a Ranke complex
• Post primary TB Endobronchial spread along nearby airways is a relatively
common finding, resulting in relatively well-defined 2-4 mm nodules or branching
lesions (tree-in-bud sign) on CT

50. Alobar holoprosencephaly Ultrasound
• monoventricle
• fused thalami
• absent corpus callosum
• absent interhemispheric fissure
• absent cavum septi pellucidi
• absence of 3rd ventricle
• middle and anterior cerebral arteries may be replaced
by tangled branches of internal
carotid and basilar vessels
VS Hidrancephaly
alobar holoprosencephaly +/- very large
dorsal cyst of holoprosencephaly
usually coexisting midline facial
abnormalities
no falx
residual rind of cortical tissue often has a
cup or pancake morphology, fused across
the midline anteriorly

51. MRI
 single midline monoventricle (or holosphere)
 lateral and third ventricles are absent
 absent midline structures
 absent septum pellucidum
 agenesis or hypoplasia of the corpus callosum
 absent interhemispheric fissure and falx cerebri
 absent olfactory tract
 dorsal cyst of holoprosencephaly
 absent, fused or normal optic nerves
 middle and anterior cerebral arteries may be replaced
by tangled branches of internal carotid and basilar
vessels

52. MCU-Neurogenic bladder, VUR, diverticulosis
• dysfunctional urinary bladder that results from an injury to the central or peripheral
nerves that control and regulate urination
• Enlarged elongated trabeculated urinary bladde / pine tree app or Christmas tree

53. Conventional OSA
• malignant bone forming tumors.
• They can be classified into primary and secondary forms, as
well as histologic types, of which conventional
osteosarcoma is the most common.
Plain radiograph
medullary and cortical bone destruction
wide zone of transition, permeative or moth-eaten appearance
aggressive periosteal reaction
sunburst type
Codman triangle
lamellated (onion skin) reaction: less frequently seen
soft-tissue mass
tumor matrix ossification/calcification
variable: reflects a combination of the amount of tumor
bone production, calcified matrix, and osteoid
ill-defined "fluffy" or "cloud-like" compared to the rings
and arcs of chondroid lesions

54. MRI
T1
soft tissue non-mineralized component:
intermediate signal intensity
mineralized/ossified components: low signal
intensity
peritumoral edema: intermediate signal intensity
scattered regions of hemorrhage will have a
variable signal
enhancement: solid components enhance
T2
soft tissue non-mineralized component: high signal
intensity
mineralized/ossified components: low signal
intensity
peritumoral edema: high signal intensity

55. Esophageal achalasia
ES
• failure of organized esophageal peristalsis causing impaired
relaxation of the lower esophageal sphincter, and resulting in food
stasis and often marked dilatation of the esophagus.
• loss/destruction of nitregenic neurons in the Auerbach/myenteric
plexus
• Obstruction of the distal esophagus from other non-functional
etiologies, notably malignancy, may have a similar presentation and
have been termed "secondary achalasia" or "pseudoachalasia".
Chest radiograph findings include:
• convex opacity overlapping the right mediastinum.
• air-fluid level due to stasis in a thoracic esophagus filled with
retained secretions and food
• small or absent gastric bubble
• anterior displacement and bowing of the trachea on the lateral
view
• patchy alveolar opacities, usually bilateral, may be seen. These
represent acute pneumonitis or chronic aspiration pneumonia
related to dysphagia.

56. FLUOROSCOPY W/ BARIUM MEAL
 bird beak sign
 esophageal dilatation
 tram track appearance: central longitudinal lucency
bounded by barium on both sides
 incomplete lower esophageal sphincter relaxation
that is not coordinated with esophageal contraction
 pooling or stasis of barium in the esophagus when
the esophagus has become atonic or non-contractile
(a late feature in the disease)
 visualize sphincter relaxation and barium emptying