Secondary achalasia caused by peripheral cholangiocarcinoma in left lobe of the liver

Secondary achalasia caused by malignancy is an infrequent disorder. A 61-year-old woman presented with dysphagia and 8 kg weight loss during 8 months. Barium esophagography showed an esophageal dilatation with smooth tapering at the distal esophagus near the lower esophageal sphincter (LES). Endoscopic ultrasonography demonstrated loss of normal layering and wall thickening at LES area. CT revealed a 5 cm sized low density mass adjacent to the esophagogastric junction in left lobe of the liver, which was confirmed as cholangiocarcinoma. It is the first report of the secondary achalasia caused by peripheral cholangiocarcinoma in left lobe of the liver. This case highlights the fact that endoscopic ultrasonography and cross-sectional imaging such as CT must be required in the case of recent onset of dysphagia in older patient to rule out secondary achalasia.