Thorax 1982;37:776-777

Achalasia of the oesophagus is a rare cause of acute thoracic inlet compression. ' We describe a case of previously un-diagnosed achalasia presenting in a young man with symptoms consistent with tracheal compression of insidious onset, in whom the maximum flow-volume loop showed a pattern compatible with severe variable intrathoracic airway obstruction that improved after cardiomyotomy. Case report A 19-year-old man presented to the outpatientdepartmentwith a two-year history ofgradually increasing shortness ofbreath on exertion, noisy breathing, recurrent coughing, particularly at night, and a "crackly " retrosternal sensation on inspiration. Only on direct questioning did he admit todysphagia, which had been present for about three years and which was associated with nocturnal regurgitation offood