Dysphagia aortica presenting as esophageal food impaction associated with a large aortic aneurysm: a case report

Background: Dysphagia aortica is a rare cause of esophageal dysphagia resulting from extrinsic compression by an abnormal thoracic aorta. It predominantly affects older individuals and may cause severe esophageal narrowing. Case Presentation: A 29-year-old man presented with acute dysphagia, regurgitation, chest discomfort, and inability to tolerate oral intake following solid food ingestion. Urgent upper gastrointestinal endoscopy revealed an impacted esophageal food bolus, which was successfully removed, providing immediate symptomatic relief. Subsequent examination demonstrated marked esophageal narrowing caused by apparent extrinsic compression without an intrinsic obstructing lesion. Contrast-enhanced computed tomography (CECT) with three-dimensional vascular reconstruction identified a large saccular lesion, described as a descending thoracic aortic aneurysm, measuring approximately 4.8 × 5.3 × 4.7 cm at the carinal level, with mural thrombus and adjacent hematoma. The lesion extended posteriorly behind the esophagus, producing significant compression, anterior displacement, and proximal dilatation. No active contrast extravasation was reported. Dysphagia aortica was diagnosed based on endoscopic and radiological findings. The patient received dietary advice and was promptly referred for vascular surgical assessment. Available imaging information could not distinguish a true aneurysm from a pseudoaneurysm or exclude a contained leak. Subsequent treatment and long-term outcomes were unavailable. Conclusion: This case demonstrates an unusual presentation of dysphagia aortica as acute food bolus impaction in a young adult. Persistent extrinsic esophageal narrowing following disimpaction warrants cross-sectional imaging to identify potentially serious vascular abnormalities. Although endoscopic treatment relieved the acute obstruction, the underlying vascular outcome remains unknown.