We report on a case of oesophageal leiomyoma presenting as a potential cause of sudden airway obstruction. The patient presented with a large mass in the oral cavity after an episode of forceful vomiting. The operative findings and histology of which confirmed this to be an oesophageal leiomyoma emanating from the upper oesophagus, a rare finding. The mass was excised and the patient's subsequent post-operative recovery and follow-up has been unremarkable. This diagnosis should be borne in mind when one is referred the odd-sounding case of a patient who appears to have 'coughed up their tonsil'.