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A n 85 year old man was admitted with acute dysphagia after eating steak. Apart from a history of hypertension he was otherwise fit and well. Further examination and a standard soft tissue neck radiograph were normal. Although the need for chest radiography was questioned, this actually revealed the cause of the problem: a large thoracic aortic aneurysm (see fig 1).
A water soluble contrast swallow was performed which showed a meat bolus in the upper oesophagus just above the level of the aortic aneurysm (see fig 2). This was subsequently removed with great care using rigid oesophagoscopy, while a consultant gastroenterologist provided flexible endoscopy cover. The patient was later referred for a cardiothoracic opinion.
This uncommon cause of acute upper oesophageal obstruction highlights the importance of obtaining a chest radiograph in every case.