A Tight Spot

a 0 PRESENTATION On occasion, patients are surprised to discover that they have lived for decades with a congenital anomaly. This was the case for a 48-year-old woman who had progressively increasing dysphagia over a period of several years. Significant worsening over 3-4 weeks spurred her to again seek medical attention for this condition. She reported difficulty swallowing solid food and a feeling of retrosternal obstruction upon swallowing. Results of an upper endoscopy and biopsies performed a few months earlier had been normal. The patient had a history of breast cancer. A left-sided mastectomy and reconstructive surgery were followed by chemotherapy. Her physical examination and laboratory data were unremarkable.