A 14-year-old female with difficulty swallowing.

A14-year-old female presented to the emergency department (ED) for the evaluation of difficulty swallowing. She experienced no headache, visual changes, respiratory abnormalities, unusual ingestions, hematemesis, or bilious vomiting. The rest of her review of symptoms was negative except for dizziness upon standing. Her medical history was significant for seeking medical care at another facility 7 months prior for gradually worsening epigastric pain that began at age 8 or 9 years. The pain was described as a “feeling like food was stuck.” She vomited food often after meals and felt the need to drink large amounts of water with eating in order to “push food down.” As part of the