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de Boer HH, O'Donnell C. An atypical case of fatal 'esophageal apoplexy': post-mortem findings and differential diagnosis. Int J Legal Med 2024:10.1007/s00414-024-03280-6. [PMID: 38926244 DOI: 10.1007/s00414-024-03280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
Forensic pathologists need to have comprehensive knowledge of a large variety of causes of sudden natural death. We describe a case of sudden and unexpected death in woman in her sixties due to rupture of a large paraesophageal hematoma. The post-mortem examination and differential diagnosis are discussed. The combined findings of whole-body post-mortem CT imaging (PMCT), targeted PMCT angiography, autopsy, and histology are most in keeping with 'esophageal apoplexy'; a rare cause of hemorrhage in the esophageal wall. A review of the literature indicates that most cases of esophageal apoplexy are self-limiting and that fatal complications are exceedingly rare. Our case demonstrates that esophageal apoplexy can present as sudden unexpected death.
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Affiliation(s)
- Hans H de Boer
- Victorian Institute of Forensic Medicine / Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine / Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
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2
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Guo C, Mei J, Guan P, Lin F, Pu Q, Liu L. Unusual clotted haemothorax caused by spontaneous intramural haematoma of the oesophagus: a case report. J Thorac Dis 2017; 8:E1594-E1596. [PMID: 28149589 DOI: 10.21037/jtd.2016.12.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Spontaneous intramural haematoma of the oesophagus (SIHO) is a relatively rare event with benign courses. Most of the patients with SIHO may experience spontaneous healing without complications. We report a case of SIHO with clotted haemothorax. Uniportal video-assisted thoracic surgery (VATS) was successfully applied as a diagnostic and therapeutic method. Although conservative treatment is adequate for the majority of patients with SIHO, uniportal VATS may be a suitable option if there was clotted haemothorax.
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Affiliation(s)
- Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Pujun Guan
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
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3
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Chen YY, Su WP, Fang HY. Unusual chest pain. Gastroenterology 2015; 148:e7-9. [PMID: 25824358 DOI: 10.1053/j.gastro.2014.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/31/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Yang-Yuan Chen
- Division of Gastroenterology, Chest Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Pang Su
- Division of Gastroenterology, Chest Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hsin-Yuan Fang
- Division of Gastroenterology, Chest Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
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4
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Jeong ES, Kim MJ, Yoo SH, Kim DH, Jung JS, Koo NH, Chang SH. Intramural hematoma of the esophagus after endoscopic pinch biopsy. Clin Endosc 2012; 45:417-20. [PMID: 23251891 PMCID: PMC3521945 DOI: 10.5946/ce.2012.45.4.417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 12/22/2022] Open
Abstract
Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.
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Affiliation(s)
- Eun Soo Jeong
- Division of Gastroenterology, Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
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Katabathina VS, Restrepo CS, Martinez-Jimenez S, Riascos RF. Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics 2012; 31:1141-60. [PMID: 21768244 DOI: 10.1148/rg.314105177] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Given their high frequency, mediastinal emergencies are often perceived as being a result of external trauma or vascular conditions. However, there is a group of nonvascular, nontraumatic mediastinal emergencies that are less common in clinical practice, are less recognized, and that represent an important source of morbidity and mortality in patients. Nonvascular, nontraumatic mediastinal emergencies have several causes and result from different pathophysiologic mechanisms including infection, internal trauma, malignancy, and postoperative complications, and some may be idiopathic. Some conditions that lead to nonvascular, nontraumatic mediastinal emergencies include acute mediastinitis; esophageal emergencies such as intramural hematoma of the esophagus, Boerhaave syndrome, and acquired esophagorespiratory fistulas; spontaneous mediastinal hematoma; tension pneumomediastinum; and tension pneumopericardium. Although clinical findings of nonvascular, nontraumatic mediastinal emergencies may be nonspecific, imaging findings are often definitive. Awareness of various nonvascular, nontraumatic mediastinal emergencies and their clinical manifestations and imaging findings is crucial for making an accurate and timely diagnosis to facilitate appropriate patient management.
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Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA.
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6
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Endoscopic Ultrasound Images of Esophageal Intramural Hematoma. J Med Ultrasound 2010. [DOI: 10.1016/j.jmu.2010.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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7
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Diagnosing Mallory-Weiss in the ED. Am J Emerg Med 2009; 27:1010. [PMID: 19857424 DOI: 10.1016/j.ajem.2009.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 07/19/2009] [Indexed: 11/21/2022] Open
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Meyer MM, Levine EJ. Cricopharyngeal intramural hematoma: an unusual complication of orthopedic intervention. Dysphagia 2009; 24:438-40. [PMID: 19472006 DOI: 10.1007/s00455-009-9218-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 03/03/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Marty M Meyer
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, OH, 43210, USA.
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Kwon CI, Ko KH, Kim HY, Hong SP, Hwang SG, Park PW, Rim KS. Bowel obstruction caused by an intramural duodenal hematoma: a case report of endoscopic incision and drainage. J Korean Med Sci 2009; 24:179-83. [PMID: 19270837 PMCID: PMC2650968 DOI: 10.3346/jkms.2009.24.1.179] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/29/2008] [Indexed: 12/12/2022] Open
Abstract
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10 x 5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
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Affiliation(s)
- Chang-Il Kwon
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Kwang Hyun Ko
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Hyo Young Kim
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Seong Gyu Hwang
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Pil Won Park
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Kyu Sung Rim
- Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
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Katz DS, Yam B, Hines JJ, Mazzie JP, Lane MJ, Abbas MA. Uncommon and Unusual Gastrointestinal Causes of the Acute Abdomen: Computed Tomographic Diagnosis. Semin Ultrasound CT MR 2008; 29:386-98. [DOI: 10.1053/j.sult.2008.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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11
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Restrepo CS, Lemos DF, Ocazionez D, Moncada R, Gimenez CR. Intramural hematoma of the esophagus: a pictorial essay. Emerg Radiol 2007; 15:13-22. [PMID: 17952475 DOI: 10.1007/s10140-007-0675-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 09/20/2007] [Indexed: 12/22/2022]
Abstract
Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients may be treated conservatively with good outcome.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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