A 20 year-old Quarter Horse gelding presented to the Cornell University Equine Hospital for evaluation of weight loss, poor doing and lack of response to treatment 19 days after an esophageal obstruction (commonly referred to as “choke”). At presentation, the patient was tachycardic, tachypneic, dyspneic, dehydrated, underconditioned and afebrile. Lung sounds were absent in ventrally bilaterally. Thoracic ultrasound examination revealed excessive fluid and fibrin accumulation. Abdominal ultrasound showed free fluid. Differential diagnoses included aspiration pneumonia or esophageal rupture secondary to prior choke episode, diaphragmatic rupture or neoplasia. This case report is followed by a discussion of common etiologies of esophageal obstruction, along with, appropriate treatment options and sequelae to the condition.