)Ĭhest X-ray: the whole oesophagus appears distended with air-fluid level ( left) Oesophagogram: the swallowed contrast agent accumulates in the oesophagus and the cardia shows a ‘rat-tail’ appearance ( right).Oesophageal peristalsis was not observed however, a minimal and constant passage of barium solution through the oesophageal hiatus was documented without the opening of the lower oesophageal sphincter (LES). Notably, the lateral chest radiograph showed an anteriorisation of the trachea. The administration of the barium contrast medium confirmed the oesophageal ectasia, with a narrowing of the cardia resulting in a ‘rat-tail’ image (Fig. A preliminary anteroposterior chest X-ray showed an enlargement of the mediastinum due to a significant oesophageal dilatation with an air-fluid level in the middle and distal thirds of the oesophagus (Fig. Consequently, the allergist recommended a barium swallow test. Furthermore, upon the execution of spirometry tests, a reduced peak expiratory flow rate and an obstructive trend without broncho-reversibility were found. The allergological evaluation yielded a positive prick test for dust mites. His previous medical history was uneventful. In the last 6 months, he had also felt a ‘weight sensation’ at the diaphragmatic level of the thorax and suffered from dysphagia, especially with solid food consumption. Furthermore, the boy reported having a nocturnal cough 3–4 times a week for the last 3 months, sometimes associated with the vomiting of gastric contents. He reported the onset, some months before, of dyspnoea without wheezing while running, which symptom remitted with rest. A 12-year-old boy was referred to the department of paediatric allergology because of a cough and difficulty breathing during exertion.