This is a case supporting the use of plain film radiography in a patient presenting with symptoms suggestive of an esophageal food bolus impaction. The patient presented with a foreign body sensation in her chest after eating chicken the night before. She complained of nausea after oral intake. She had an emergency department (ED) visit with a plain film of the chest and chest pain work up the night prior to presentation. On her return visit to the ED, the patient appeared to tolerate oral intake, but a plain film demonstrated a fluid level in the esophagus with proximal dilation. In light of this plain film finding, the patient underwent emergent endoscopy with prompt removal of the food bolus and diagnosis of the underlying etiology. This case report suggests that if a patient is able to tolerate a small volume of oral liquids yet remains symptomatic, a plain film of the chest may be helpful in diagnosis of an obstruction with a radiolucent food bolus.TopicsPlain film, esophageal food bolus impaction, esophagitis, esophageal dysmotility, obstruction.