A case of spontaneous intramural hematoma of the esophagus

The Conundrum of Treating Portal Vein Thrombosis and Submucosal Esophageal Hematoma

Submucosal esophageal hematoma (SEH) is an uncommon clinical entity and a rare form of esophageal insult. Patients usually present with retrosternal chest pain and dysphagia, which often make the diagnosis of SEH difficult as it mimics common cardiovascular and pulmonary disorders. One of the common inciting factors includes the use of anticoagulants. In this report, we discuss the case of a patient with portal vein thrombosis who was treated with heparin and consequently developed SEH.

Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis

Dissecting intramural hematoma of the esophagus (DIHE) is a rare condition in which intramural hemorrhage can lead to submucosal dissection of the esophageal wall. DIHE is generally considered a benign disease, and the only mortality associated with DIHE has been due to operative intervention or to the presence of another underlying, life-threatening condition. We report, however, a case of sudden death due to the spontaneous rupture of a DIHE that occurred in a 32-year-old woman, affected by neurofibromatosis type 1. She was admitted to the local emergency room, presenting a 24-hour history of sudden onset, severe central chest and interscapular pain associated with dysphagia, odynophagia and vomiting. Her condition worsened and proved fatal within a 6-hour period. A complete autopsy was then conducted, showing a complete dissecting intramural hematoma with laceration of the third superior of the esophagus. We can hypothesize that abnormal variations of gastro-esophageal pressure during ingurgitation and during bolus movement could be predisposing factors in the pathogenesis of the dissection. On the other hand angular kyphoscoliosis deformity may have had play a role as precipitating factor while vomiting in the subject's medical history can then be interpreted as the likely activation phenomenon.

Intramural haematoma of the oesophagus presenting as an unusual complication of endotracheal intubation

Intramural haematoma of the oesophagus is an uncommon and under-recognized condition. It may mimic other causes of chest pain, haematemesis, or dysphagia, and hence pose a diagnostic challenge. We report a case of an unusual presentation of intramural haematoma of the oesophagus occurring as a presumed complication of endotracheal intubation. It was disguised as acute onset post-operative chest pain, and resolved with conservative management. Awareness of this uncommon complication is important to allow rapid and timely diagnosis and management. We review the literature, causes and imaging features of this condition.

Oesophageal dissection: contrast studies and CT in diagnosis and monitoring

Oesophageal dissection with intramural haematoma formation can be difficult to diagnose. Endoscopy can be diagnostic, but imaging techniques including computed tomography and contrast swallows can both accurately demonstrate a dissection and exclude many other pathologies. A case utilizing both imaging modalities to diagnose and monitor the condition in a patient with a bleeding disorder is presented.

Spontaneous intramural hematoma localized in the proximal esophagus: truly "spontaneous"?

After a usual meal, a 57-year-old woman with normal hemostasis experienced a hematoemesis. She was then diagnosed endoscopically as having an intramural hematoma of the esophagus, which ranged from 18 cm to 24 cm from the incisors. The hematoma is considered to have developed not "spontaneously" but as a result of direct abrasive trauma by foodstuffs. The authors think it appropriate to use the term "spontaneous" only when the development of hematoma is unrelated to emetogenic events, impaired hemostasis, and food-induced injury.