Macaroni for dinner: The mysterious case of a dilated esophagus

esophagusA recent case report in a recent issue of Clinical Autonomic Research describes a 54-year old man with familial dysautonomia (FD) who ended up in the emergency room unconscious and not breathing.

In the ER, he underwent cardiopulmonary resuscitation and the content of his mouth and throat was suctioned. Fortunately, he started breathing on his own again. In an effort to find out why he suddenly stopped breathing, he was sent for a high-resolution computerized tomography (CT) scan of the chest. This non-invasive imaging method allows you to view the thorax in great detail, including the heart, the lungs and the airway, and the upper part of the gastrointestinal system.

Quite unexpectedly, the CT scan revealed elbow shaped small curved tubes filling his esophagus – the muscular tube leading from the mouth to the stomach. Perplexed, the medical team was left scratching their heads trying to understand exactly what these curved tubes were. The now conscious patient revealed he had had mac and cheese for dinner right before becoming unconscious. The macaroni had remained undigested in his esophagus since then.

The esophagus is the part of the gastrointestinal tract that stems from the back of the throat to the stomach. It is controlled by a whole series of nerves, which coordinate the movement of the muscles that propel food down into the stomach.

524619169Patients with FD are born with fewer nerves along the entire length of the gastrointestinal tract. As a result, the motility of the gut is disturbed. The esophagus can become dilated and impacted with food. This is a condition known as megaesophagus.

In the case of this gentleman, the undigested macaroni sitting in his megaesophagus were aspirated into his lung, which blocked his air supply resulting in respiratory failure.

We don’t often think of the dangers of the food stuck in the esophagus as a potential source of material that can be aspirated into the lung. This case is important as it alerts us that the possible dangers of eating might not end with the last bite.


The study was published in Clinical Autonomic Research and was supported by the Dysautonomia Foundation, Inc.

Palma JA, Spalink C, Barnes EP, Norcliffe-Kaufmann L, Kaufmann H. Neurogenic dysphagia with undigested macaroni and megaesophagus in familial dysautonomia. Clin Auton Res. 2018 Feb;28(1):125-126. doi: 10.1007/s10286-017-0487-6. PMID: 29196937