Idiopathic Diffuse Muscular Hypertrophy of the Lower Oesophagus

There is a curious and little-known pathological change in the oesophagus in which the musculature of the lower half is greatly and diffusely thickened whilst the lumen is of normal diameter.This con- dition was probably described by Matthew Baillie in 1799, but since then has attracted little interest.It seems justifiable to add a further seven cases to the 25 reported in the literature.An attempt will be made to clarify the aetiology of this condition.Attention will also be drawn to the means by which it may be diagnosed in life, for it will be shown that the underlying functional disturbance is probably a diffuse lower oesophageal spasm, a change which has in recent years been recognized with increasing frequency by radiologists, but about the pathology of which little is as yet known.CASE REPORTS CASE 1 (Index number 30351/1923.Medical).-G.H., a man aged 53 years, was admitted to the London Hospital on January 31, 1923.For the past two months he had had a cough with pain in the chest and dyspnoea.He had lost a great deal of weight.His condition deteriorated and he died on March 5, 1923.The patient had no history relevant to the oeso- phagus.Summary of Necropsy (P.M. 121/1923).-Therewas a carcinomatous mass (9 by 6 by 6 cm.) in the hilum of the left lung, with great infiltration of the hilar glands.This growth was composed of solid acini of oat cells and spindle cells, and of tubules lined by cubical and columnar epithelium.There were numerous secondaries in the liver and bones.The lower lobe of the left lung showed broncho- pneumonia.The heart was slightly enlarged (361 g.).Appearance of the Oesophagus.-There was hyper- trophy without dilatation of the oesophagus, gradually increasing from the upper end (0.3 cm.thick) to the lower end (1 cm.thick), but without any additional thickening at the cardia.The mucosa was white and smooth.