Esophageal achalasia is a rare condition affecting both men and women. It is a motility disorder of the esophagus resulting in the lack of relaxation of the lower sphincter, yielding to food stasis. While the condition typically presents with dysphagia and regurgitation, advanced stages may lead to severe complications including dyspnea and even acute respiratory distress. We herein report the case of a patient admitted to an intensive care unit following emergency prehospital management for acute respiratory failure and hemodynamic instability. The patient required invasive mechanical ventilation and vasopressor support due to tracheal compression and involvement of the cardiac, arterial, and venous structures. The diagnosis of esophageal achalasia was initially suspected. Based on CT, endoscopic esophageal decompression was performed, the situation dramatically improved, and diagnosis was subsequently confirmed by esophageal manometry.