Dysphagia Secondary to Extrinsic Esophageal Compression From an Anterior Mediastinal Squamous Cell Carcinoma

Dysphagia is commonly attributed to intrinsic esophageal pathology; however, extrinsic compression from mediastinal processes remains an important and often underrecognized cause. We report the case of a 69-year-old man who presented with acute dysphagia due to food impaction. Esophagogastroduodenoscopy successfully relieved the obstruction but revealed no intrinsic lesion, instead demonstrating extrinsic compression of the upper esophagus. Subsequent cross-sectional imaging identified a large anterior mediastinal mass extending into the left neck, encasing the aortic arch and its branches, and causing significant esophageal deviation and stenosis. Laboratory evaluation was notable for leukocytosis, anemia, elevated inflammatory markers, and an elevated carcinoembryonic antigen level. Initial attempts at tissue diagnosis, including ultrasound-guided axillary lymph node sampling and endobronchial ultrasound-guided transbronchial needle aspiration, were nondiagnostic due to insufficient or nonrepresentative tissue. Given persistent high clinical suspicion, further tissue sampling was pursued, ultimately establishing a diagnosis of squamous cell carcinoma. This case highlights the diagnostic limitations of endoscopy in the evaluation of extraluminal disease, the challenges of tissue acquisition in mediastinal pathology, and the critical importance of persistence following nondiagnostic biopsies. An imaging-driven, multidisciplinary approach is essential for accurate diagnosis and timely management in patients with suspected mediastinal malignancy.