Primary tracheal tumors are rare. Typically slow growing, they present late in the course of disease, with obstructive respiratory symptoms. A 25-year-old man developed external substernal chest pain and pressure with dyspnea that were relieved with rest. Noninvasive evaluation identified a tracheal tumor, adenoid cystic carcinoma by biopsy, which was previously undescribed as a cause of pseudo-angina pectoris. The patient's evaluation, management, and 20-month follow-up are presented. A mechanism for the patient's noncardiac exertional chest pain is proposed. Previous experience with adenoid cystic carcinomas of the trachea is reviewed.