These images belong to a 30-yr-old man who underwent an arthroscopic knee meniscal repair. He had a body mass index of 29 kg/m2 and endorsed occasional mild gastroesophageal reflux after spicy food. Induction of anesthesia was unremarkable. A laryngeal mask airway (LMA) was inserted with a 14-French gastric tube inserted through the gastric port. The suction of the gastric tube yielded only trace amounts of gastric fluid. After a lung recruitment maneuver at pressure 35 cm H2O, particulate gastric material was noted in both the gastric and airway ports of the LMA. The patient was managed as per intraoperative aspiration protocol. Postoperatively, a chest roentgenogram revealed a central longitudinal opacity, which represents the outline of the dilated esophagus (fig. 1). Chest tomography showed that the patient’s esophagus was markedly dilated across its entire length, consistent with a diagnosis of achalasia (fig. 2). Upon...

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