This is a case of thrombosed primary cervical esophageal varices causing acute respiratory distress. Unlike other types of esophageal varices these lesions probably follow a benign course with only rare complications. They may arise from an anomalous hypopharyngeal venous plexus and should be easily diagnosed at endoscopic or radiographic examination. It is important to differentiate these lesions from secondary cervical esophageal varices. Primary cervical esophageal varices may be managed conservatively while secondary cervical esophageal varices require management directed at the cause of superior vena caval obstruction.