Title : Beyond typical presentations: Unilateral bronchiectasis as a rare consequence of achalasia cardia
Abstract:
Background: Bronchiectasis associated with achalasia cardia typically presents bilaterally due to chronic aspiration. Unilateral involvement is exceptionally rare, particularly without tracheoesophageal fistula. This report describes an unusual case of isolated left-sided bronchiectasis in a patient with previously treated achalasia.
Case presentation: A 16-year-old female with surgically treated achalasia at age 11 presented with chronic productive cough, recurrent respiratory infections, and progressive weight loss. Physical examination revealed markedly diminished vocal fremitus and absent breath sounds throughout the left hemithorax. Laboratory evaluation showed mild iron-deficiency anemia. Imaging demonstrated extensive cystic bronchiectasis confined to the left lung with complete parenchymal destruction, significant mediastinal shift, and a dilated esophagus containing fluid stasis, without evidence of tracheoesophageal fistula.
Results: Pulmonary function testing demonstrated preserved right lung function despite left-sided destruction. The patient underwent successful left extrapericardial pneumonectomy through a posterolateral thoracotomy. Histopathological examination confirmed widespread bronchiectatic changes with severe parenchymal destruction. The postoperative course was uneventful, with significant improvement in respiratory symptoms and general condition.
Conclusion: This case highlights unilateral bronchiectasis as a rare consequence of achalasia cardia, even without tracheoesophageal fistula. Pneumonectomy proved effective in our carefully selected young patient with destroyed left lung and preserved contralateral function. Clinicians should consider achalasia in the differential diagnosis of unexplained unilateral bronchiectasis, regardless of prior treatment for the esophageal disorder.
Keywords: Achalasia cardia, bronchiectasis, Pneumonectomy, destroyed lung, Case report
