Hiding in Plain Sight: An Unusual Case of Progressive Dysphagia, Dyspnea and Dysphonia

An 87-year-old woman presented with progressive solid food dysphagia that had been on-going for over 10 years. Her medical history included sarcoidosis, atrial fibrillation, hypertension, and a right-sided hemicolectomy for cecal adenocarcinoma. During gastroenterological consultation in a secondary setting, a barium swallow test revealed severe dilation of the proximal and distal esophagus, stasis of the bolus at the level of the aortic arch, and a “rat-tail” appearance of the esophagogastric junction (Fig. 1). Subsequent gastroscopy showed atony, esophageal dilation, and a narrowed tortuous segment in the distal esophagus (Fig. 2). Dilation was performed with Savary bougies up to 16 mm; however, this did not improve her swallowing. Although no definitive diagnosis could be made, a long-standing non-specific esophageal motility disorder was suspected. As her symptoms were mild, the patient agreed to conservative management with observation.