Images of Memorable Cases: Case 95 Chest radiograph of a 61-year-old man with a history of long-standing dysphagia and frequent vomiting. 95. Achalasia At first glance, the image suggests cardiomegaly consequent to pericardial effusion or dilated myocardium. On closer inspection, however, the right “heart” border is somewhat irregular and ill-defined. A barium swallow (image below) showed that the abnormal “cardiac” configuration represented a dilated esophagus. The medical literature appropriately indicates that the dilated esophagus in patients with achalasia can sometimes be mistaken on chest radiographs for mediastinal or pulmonary disease. This case demonstrates that a dilated esophagus can also mimic cardiomegaly.