Cricopharyngeal Achalasia
Michael P. Federle, MD, FACR
Key Facts
Terminology
Failure of cricopharyngeal muscle (upper esophageal sphincter) relaxation due to hypertrophy or spasm
Imaging
Prominent cricopharyngeus muscle at pharyngoesophageal junction with retention of barium in pharynx on lateral view
Pharyngoesophageal junction: C5-6 level
Videofluoroscopic recording: Frontal/lateral/oblique
Rapid sequence required for demonstration
Top Differential Diagnoses
Cervical osteophytes (indentation)
Large anterior cervical osteophytes can impinge on pharyngoesophageal junction simulating cricopharyngeal achalasia
Esophageal tumor
Tumor at pharyngoesophageal junction may constrict lumen concentrically or eccentrically
Pathology
Usually just “poor timing” of CP contraction
Due to “presbyesophagus” or other cause of dysmotility in most cases
Clinical Issues
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