Medical history Male patient, 66 years old, from the region of Itabira, presents progressive dysphagia for 5 years, evolving with regurgitation, heartburn, tolerance for pasty food and liquids only, and involuntary weight loss of 10kg. The patient has a cardiac pacemaker and hypertension, with history of smoking (56 pack years) and alcoholism. Upper gastrointestinal endoscopy (UGIE): dilated esophagus, with high quantity of aspirable clear residue. Esophagogram with barium sulfate requested. Image 1: Esophagogram with barium sulfate, patient in orthostatism, posteroanterior view. Esophagogastric transition. Question Considering the clinical and radiological findings, what is the most likely diagnosis? Esophageal carcinoma Chagas megaesophagus group III (Rezende's Classification) Pseudoachalasia secondary to esophageal carcinoma Chagas megaesophagus group IV (Rezende's Classification) Test question [UFT Medical Residency 2014 - Trauma and Vascular Surgery] Concerning the chagasic megaesophagus, we can affirm that: The upper gastrointestinal endoscopy has a high sensitivity and specificity for its diagnosis, allowing the classification according to the degree of dilation Endoscopic treatment with dilation and injection of botulinum toxin is used in any phase of the disease, being superior to surgical results Patients with low surgical risk must be submitted to esophagectomy, since the disease raises the risk of esophageal cancer The radiological exam with oral contrast must be avoided due to the high risk of bronchoaspiration The upper gastrointestinal endoscopy is indispensable for the evaluation of the esophageal mucosa, in the patients with chagasic megaesophagus Time is Up! Time's up
