In one case, a 66-year-old woman was found dead in her home. There was no evidence of trauma, and her only past medical history was of congestive cardiac failure. At autopsy, significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging interiorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. In the second case, an 84-year-old man came to the hospital with a history of nausea and vomiting. He was found to be mildly dehydrated and was orally rehydrated successfully. He subsequently collapsed and suffered a respiratory arrest while eating. His past medical history included hypertension and dementia. An internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus, which contained approximately 50 ml of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease. 1 table, 2 figures, and 17 references