We describe a 74-yr-old man with stage III adenocarcinoma of the lung
who presented with suspected malignancy-induced secondary achalasia an
d responded clinically to intrasphincteric injections of botulinum tox
in type A (Botox, Allergen Inc., Irvine, CA). We discuss the use of bo
tulinum toxin in this setting, as well as diagnostic strategies to dif
ferentiate achalasia from pseudoachalasia.