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Images in thorax
An oesophageal and pulmonary association not to forget
  1. Bernie Young Sunwoo
  1. Correspondence to Dr Bernie Young Sunwoo, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Francisco, 2330 Post St, Suite 420, San Francisco, CA 94115, USA; bernie.sunwoo{at}

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A 45-year-old Indian man with a history of achalasia presented with fevers, cough and fatigue. He had undergone endoscopic dilatation for achalasia several years prior. Chest radiograph revealed a dilated oesophagus and a left perihilar opacity (figure 1). He was treated for community-acquired pneumonia with a course of clarithromycin but had persistent cough, fatigue and weight loss with non-resolving radiographic infiltrates. A 3-week course of amoxicillin clavulanate was prescribed for suspected aspiration with little clinical improvement, and a chest CT was performed (figure 2). The patient had never smoked and had moved to the USA from India over 20 years ago, last travelling to India 1 year prior. Prior purified protein derivative skin tests (PPDs) were negative. HIV testing was …

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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