Vascular Compression of the Esophagus: A Case of Dysphagia Aortica

Dysphagia aortica is a rare cause of external esophageal compression from an enlarged, tortuous, or aneurysmal aorta. An 85-year-old woman with a known ascending aortic aneurysm presented with several weeks of intermittent regurgitation of liquids and pills. A barium esophagram revealed a severe 40 mm long segment narrowing of the distal esophagus with delayed transit. Computed tomography angiography (CTA) revealed a 5.6 cm ascending aortic aneurysm exerting mass effect on the esophagus; endoscopy noted no intrinsic obstruction or obvious external compression. This case demonstrates the challenge of diagnosing dysphagia aortica in the setting of normal endoscopy, emphasizing the need for additional imaging.