Abnormal Iodine-131 uptake in the mediastinum caused by achalasia

A 50-year-old woman who had had surgery 4 years earlier for papillary carcinoma of the thyroid received 30 mCi I-131 for ablation. Follow-up 1-131 imaging showed successful thyroid gland ablation; however, persistent activity was present in the mediastinum corresponding to the esophageal projection. The patient had been experiencing dysphagia for approximately 10 years. Esophageal scintigraphy showed delayed transit time. A contrast esophagogram showed a rat tail deformity with narrowing most marked at the gastroesophageal junction and dilatation of the entire esophagus. Although endoscopic examination demonstrated nonperistaltic contractions, an upper gastrointestinal endoscopic examination was normal. Because these findings suggested achalasia, we concluded that the abnormal 1-131 uptake was caused by achalasia.