Presented with desaturation ? silent aspiration.
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Barium was administered via baby's feeding bottle. It flowed slowly to opacify a dilated esophagus. There were no appreciable esophageal contractions, resulting in slow transit of barium to the stomach with an apparent tapering distally (bird beak sign) and at the esophagogastric junction. Appearances are most in keeping with achalasia. Note thymic silhouette on the left side of chest.
We had to be cautious and avoid over filling the esophagus due to pooling and slow transit of barium. Child was held upright intermittently and placed back on the fluoroscopy table to avoid aspiration.