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Esophageal carcinoma (EC) is an important tumor for the pulmonologist by virtue of its diverse thoracic manifestations. Respiratory tract fistulae occur in 5% to 15% of cases and comprise a devastating complication for which no truly satisfactory treatment exists. Lesser airway encroachment may consist of respiratory tract impingement or mucosal invasion; these must be distinguished via careful bronchoscopic assessment. Pneumonia remains the most common respiratory complication of EC and the most common cause of death. Thoracic lymphadenopathy occurs in up to 47% of cases and may occasionally cause vocal cord paralysis. Lung metastases are uncommon at diagnosis but must be distinguished from primary lung cancer, which occurs in about 3% of patients with EC. Other rare clinical manifestations of EC that relate to the practice of pulmonary medicine include nonrespiratory intrathoracic infiltration or fistula formation, clubbing and hypertrophic osteoarthropathy, malignant pleural effusion, and singultus. In conclusion, a working knowledge of the many intrathoracic complications of EC may be useful for the practicing pulmonologist.