Foregut ischemia and odynophagia in a patient with a type III aortic dissection

We report a case of ischemia of the distal esophagus with secondary odynophagia that occurred as a result of a type III aortic dissection. A 56-yr-old hypertensive male presented with acute chest pain radiating to his back. A dissection of the descending aorta was found to begin just distal to the left subclavian artery and end in the region of the iliac arteries. The patient was treated medically and remained stable, but then developed odynophagia to solids. Upper endoscopy showed erythematous friable esophageal mucosa, and biopsies were consistent with ischemia. Aortography and barium fluoroscopy provided further evidence of foregut ischemia. The patient recovered on oral omeprazole with no residual symptoms. Ischemic compromise of the esophagus secondary to aortic dissection has not been previously described, nor have the associated endoscopic findings. Knowledge of this rare condition may help in the recognition and management of esophageal mucosal ischemia.