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.
Manjikian et al. (2026) studied this question.