Question: A 27-year-old man with a past medical history notable for asthma, food allergies, and congenital pectus excavatum presented with worsening dysphagia. He reported a 5-year history of intermittent solid food dysphagia but denied any history of food impaction. A computed tomography scan of the chest showed an elongated mediastinal mass with associated mass effect on the left atrium and esophageal lumen and esophageal wall thickening without mediastinal lymphadenopathy. On upper endoscopy, a large fistulous opening in the lower third of the esophagus was found corresponding to the ‘mass’ seen on computed tomography (Figure A).