On ultrasound, leiomyoma of the esophagus is typically described as being a hypoechoic tumor located in the submucosa with a smooth contour. We report a case of esophageal leiomyoma that presented unusually as an anechoic (cyst-like) lesion on endoscopic ultrasound. Initially, a foregut cyst was suspected. As the patient had the symptom of a food sticking sensation, surgical tumor excision was performed. Pathology of the surgical specimen showed esophageal leiomyoma.