An unusual case of dysphagia.

A 72-year-old man presented with shortness of breath and vomiting of three weeks’ duration. Vomiting occurred without warning and consisted of undigested food. On the morning of this presentation, he awoke with food remnants in his nostrils and persistent coughing. The patient reported progressive difficulty with swallowing solids and liquids. He had occasional shortness of breath, constipation, and a 50-lb weight loss over the previous two years. His medical history was significant for chronic obstructive pulmonary disease and gastroesophageal ref lux disease. He had smoked one pack of cigarettes per day for more than 50 years, but did not abuse alcohol. Physical examination showed mild respiratory distress and dry mucous membranes. His breath sounds were coarse bilaterally, with soft expiratory wheezing. He had moderate epigastric tenderness. Barium esophagography and computed tomography of the chest were performed (Figures 1 and 2).