[A case of recurrent aspiration pneumonia by achalasia].

A 56-year-old woman came to our hospital with the symptoms of anorexia, body weight loss and sustained cough. Chest radiography showed diffuse, rounded, high-attenuation areas in both lung fields. The diagnosis was difficult, but, because of the symptoms and chest radiograph, we suspected miliary tuberculosis. Finally, we diagnosed her illness as achalasia with aspiration pneumonia, because we found a dilated esophagus and diffuse, rounded, high attenuation areas in chest CT scan films. Neither Mycobacterium tuberculosis nor tuberculous granulation was present in transbronchial lung biopsy specimens. Only inflammation was found in those slides. The gastrofiberscope was useful for searching for tumors, but not for diagnosing achalasia. Consequently, we identified the achalasia from the radiographic findings with the use of barium, but the patient's symptoms might not have led to that diagnosis because she was younger than the age range in which aspiration pneumonia usually occurs. The achalasia was treated with surgery rather than balloon dilation, since that was the patient's choice. Three months after surgery, her lungs had improved and body weight had increased by about 10 kg.