CLINICAL VIGNETTE ACUTE RESPIRATORY FAILURE SECONDARY TO ACHALASIA

A 77-year-old woman presented to the Emergency Department (ED) with severe respiratory distress and audible wheezing. She had no history of obstructive lung diseases. She had been diagnosed with achalasia 20 years ago and reported progressive dysphagia. She had been treated with Botox injections but these had not been effective for several years. For the past 6 years, she had required esophageal dilation for relief of symptoms every 2 years. Her last procedure was 1 year prior. For several months, she had been having increasing difficulty swallowing solid food. In the week prior, patient had 3 bouts of shortness of breath occurring after meals, each lasting for a few minutes and relieved by self-induced retching or belching. On the day of admission, she developed rapidl