Autor: Daniel Trabulo, Hospital da Luz Setúbal, Hospital da Luz Lisboa

A 67-year-old manwith total dysphagiaunderwent upper gastrointestinal endoscopythat revelaeda large esophageal diverticulum in thelower third,with solid food that was removed with a basket(Picture 1). Abdominal CT scanshoweddiverticular dilatation of the middle third and symmetricalconcentric wall thickening(Picture 2).Esophageal transit with barium contrast revealed adiverticulum in the lower third of the esophagus with 35 mmdiameterand non-propulsive, tertiaryperistaltic waves, with deficient contrast progression and fluid level formation and deficientdistensibility of the cardia. (Picture3). Esophageal manometry corroborated the diagnosis ofachalasia.