Pseudoachalasia due to an occult malignant tumor accounts for about 5% of patients presenting with clinical features of achalasia. Pleural mesothelioma is a rare cause of pseudoachalasia and may present without respiratory symptoms or chest pain.
We present two cases of pseudoachalasia from pleural mesothelioma diagnosed by laparoscopic biopsy over a 10-year period.
In both patients, the onset of the disease was atypical, with dysphagia and weight loss being the predominant symptoms; no dyspnea or chest pain was reported. Prolonged (>40 years) occupational exposure to asbestos was reported only by one of the patients. Treatment was palliative and consisted of endoscopic stenting and chemotherapy.
The diagnosis of pseudoachalasia is not always straightforward. Laparoscopy is a safe and effective method for obtaining a biopsy.