Pseudoachalasia caused by a cholangiocarcinoma in the liver

SummaryPseudoachalasia, or secondary achalasia, caused by neoplasms is a rare entity. We describe a case of pseudoachalasia in an 80-year-old woman who presented with a 2-month history of progressive dysphagia and postprandial vomiting. An esophagogram demonstrated a markedly dilated esophagus with a typical “bird-beak” appearance of the gastroesophageal junction, indicative of achalasia. However, esophageal manometric study disclosed normal peristalsis of the esophagus, not suggestive of a typical feature of achalasia. Abdominal computed tomography scan demonstrated a hypovascular tumor in the left lobe of the liver, extending to the gastroesophageal junction and proximal lesser curve of the stomach. The patient underwent a palliative gastrostomy with a liver biopsy. Finally, cholangiocarcinoma was diagnosed based on the pathological findings. Despite its rarity, clinicians should be aware of this finding as a potential cause of dysphagia in elderly patients.