Dysphagia Megalatriensis: An Uncommon Cardiac Mimicker of Gastroesophageal Dysphagia
Bibliographic record
Abstract
CASE REPORT An 82-year-old man with permanent atrial fibrillation status after atrioventricular nodal ablation and Watchman device placement presented for recurrent abdominal pain and dysphagia unresponsive to dietary modification or medications. He underwent esophageal manometry testing, which demonstrated findings concerning for grade III achalasia (Figure 1). To rule out pseudoachalasia, a computed tomography angiogram of the torso was obtained, revealing left atrium (LA) enlargement with mass effect causing compression of the lower one-third of the esophagus, resulting in mild obstruction and dilation of the proximal esophagus. A transthoracic echocardiogram then demonstrated severe LA dilation and bowing of the interatrial septum consistent with elevated LA pressures (Figure 1). With continued dysphagia, an upper gastrointestinal series revealed esophageal dysmotility and pulsion diverticulum in the mid-esophagus just above the LA (Figure 1). The patient underwent an esophagogastroduodenoscopy with esophageal stent placement (Figure 1). Notably, extrinsic compression of the mid-esophagus at the level of the LA was noted peri-procedure. This case illustrates the importance of always considering cardiac disease as an underlying etiology for persistent dysphagia. First described in 1969, dysphagia megalatriensis remains a challenging diagnosis.1 However, cardiac workup is warranted when there is true clinical suspicion.Figure 1.: (A) Esophageal manometry showing findings concerning for grade III achalasia. (B) Echocardiogram revealing severe left atrial dilation and bowing of the interatrial septum. (C) Upper gastrointestinal series revealing esophageal dysmotility and pulsion diverticulum in the mid-esophagus just above the left atrium. (D) Post-esophageal stent placement.DISCLOSURES Author contributions: L Palatnic, RR Moyer, and CJ Miranda compiled a literature review and wrote up the manuscript. CJ Miranda is the article guarantor. Financial disclosure: None to report. Previous presentation: Case presented at the American College of Gastroenterology Annual Scientific Meeting; October 23, 2023; Vancouver, BC, Canada. Informed consent was obtained for this case report.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".