Tropical Medicine Central Resource

As previously noted, in some endemic areas, chiefly Brazil, there is a high incidence of megaesophagus and megacolon and rarely dilatation and/or aperistalsis of other hollow viscera such as the stomach, duodenum, ureters, bladder, and bronchi. Certainly the combination of generalized cardiomegaly and megaesophagus or megacolon in a South American patient should suggest the diagnosis of chronic Chagas' disease to the alert radiologist (Fig. 4.39).

Fig. 4.39 Chronic Chagas' myocardiopathy and megaesophagus in a 58-year-old black Brazilian man. (A) PA view of the chest shows a prominent soft tissue density along the entire right mediastinal border due to the greatly dilated esophagus partially filled with barium and fluid. The right and left heart convexities are prominent due to enlargement of both sides of the heart. Left atrial enlargement produces a bulge along the left upper cardiac border and upward displacement of the left main bronchus. There is no pulmonary vascular congestion or pleural fluid present. The left lateral (B) and right anterior oblique (C) views show posterior displacement of the megaesophagus by the dilated left atrium. The grossly distended esophagus causes a wide area of increased soft tissue density from the apex to the diaphragm posterior to the trachea and heart outlines on the lateral view. (D) Gross cardiomegaly with enlargement of all chambers is seen on left anterior oblique view. The markedly dilated left atrium elevates the left main bronchus, while the huge left ventricle protrudes well behind the vertebral column. Clinically, the patient had a 37 pound weight loss and dysphagia for both solid foods and fluids of 7 months duration with regurgitation of food several hours after eating. His heart rate was 36 beats per minute and arrhythmic, and a systolic murmur was heard in the mitral area. Slight hepatomegaly was present. (Courtesy of Dr. Clovis Simao, Sao Paulo).