Pseudoachalasia in an Achalasia Patient: A Ticking Time Bomb

The differential for dysphagia is broad, with dysphagia aortica being an incredibly rare cause of pseudoachalasia. In a patient with longstanding, refractory achalasia who presents with progressive dysphagia, Occam's Razor would suggest that the underlying cause remains achalasia itself. We present a case in which a patient with known achalasia developed concurrent pseudoachalasia due to dysphagia aortica. This case underscores the diligence of her gastroenterologist in identifying an unsuspected aortic aneurysm—an entity that the cardiothoracic surgery team deemed “a ticking time bomb.” It is critical to always consider Hickam's dictum: Patients may have multiple diseases simultaneously.