Achalasia is a motility disorder of the esophagus consisting of abnormal relaxation of the lower esophageal sphincter and aperistalsis of the esophageal body. Esophageal dilatation and bird beak appearance are characteristic radiologic findings of achalasia, but achalasia patients do not always show typical findings on esophagography. We recently experienced a 38-year-old female patient who complained of chest pain and dysphagia. She showed no dilatation of the esophagus with delayed emptying of the contrast media in esophagography, but achalasia was diagnosed by typical manometric findings. The patient's symptoms improved after a balloon dilatation. Therefore, esophageal manometry should always be performed when the patient's history suggests the presence of achalasia without typical radiologic findings. We report this case with a review of the literature.