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Surgical resection was successfully performed, and the patient had complete resolution of her symptoms. A follow-up visit revealed a postoperative complication of left vocal cord palsy. Speech-language therapy was recommended. CONCLUSIONS Esophageal leiomyoma can present solely with respiratory symptoms without any gastrointestinal involvement and can be misdiagnosed because of atypical symptoms, uncommon location, or atypical imaging features. Recognizing the imaging features and pathologic basis of esophageal leiomyoma is essential for

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