Dysphagia aortica from endovascular leak after thoracic endovascular aneurysm repair

Achalasia is an esophageal motility disorder that causes peristaltic dysfunction and failure of the lower esophageal sphincter (LES) to relax upon swallowing. Pseudoachalasia is a mimicker of achalasia, but its pathophysiology and treatments are different. We present a case of an elderly woman with dysphagia. Manometry was most consistent with type II achalasia. Ultimately, the diagnosis of dysphagia aortica causing pseudoachalasia from a large, compressing thoracic aorta endoleak after a thoracic endovascular aneurysm repair (TEVAR) was made. This diagnosis altered her management course, avoiding possible intervention such as peroral endoscopic myotomy (POEM) versus laparoscopic Heller myotomy (LHM).