The various esophageal conditions that can cause sudden and/or unexpected death are presented under the broad categories of obstruction, perforation, hemorrhage, rupture, and "miscellaneous." Obstructions in the esophagus that can cause asphyxiation include the presence of foreign bodies that block the airway, such as food or material accidentally swallowed, and the presence of some type of tumor that reaches a size sufficient to block respiration. Perforation involves the penetration of the wall of the esophagus by some means, resulting in the breaking of the wall of a nearby artery, leading to a massive hemorrhage. Bones from eating fish or chicken could cause such a condition. Acute hemorrhage may also result from fistulas between the esophagus and major blood vessels, but is more likely to result from a ruptured intraesophageal varix. This most often results from portal hypertension caused by liver cirrhosis. Other causes of hemorrhages that stem from an esophageal conditions are other vascular abnormalities, Mallory-Weiss tears (lacerations at the gastroesophageal junction), and an intramural hematoma associated with coagulation disorders or the use of anticoagulant drugs. Ruptures of the esophagus are discussed as related to Boerhaave syndrome (spontaneous rupture of the esophagus due to a sudden increase in intraluminal pressure during forceful vomiting) and iatrogenic events (ingestion of caustic substances in childhood that cause scarring and narrowing of the esophageal luminal diameters). For each of these causes of death related to a condition of the esophagus, signs to look for in an autopsy are noted. 5 figures and 41 references