Intramural Hematoma Of Esophagus Research Articles

Intramural Esophageal Hematoma With Associated Hemothorax

Intramural esophageal hematoma (IEH) is a rare manifestation of esophageal wall injury with nonspecific symptoms. It may be caused by trauma or occur spontaneously. IEH is often discovered on computed tomography or esophagogastroduodenoscopy and is typically managed conservatively with supportive care to allow healing. It is frequently an isolated finding in the esophagus and seldom involves any other organ. We report a rare case of a patient discovered to have an obstructing IEH with associated hemothorax after an unrelated surgical admission.

Rare case of intramural esophageal hematoma associated with betel nut consumption.

A 47-year-old man who experienced sudden retrosternal pain and dysphagia for 2 days was admitted to the emergency room. While his physical examination and laboratory results were unremarkable, results of esophagogastroduodenoscopy revealed a longitudinal, purplish-red, and cystic submucosal emanation throughout the esophagus, fluctuating with respiration ([Fig. 1 a], [Video 1]). Mucosal erosion was noted but without obvious rupture. We therefore suspected an esophageal intramural hematoma.

Abstract 11378: Spontaneous Esophageal Hematoma in Chronically Anticoagulated Atrial Fibrillation

Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

A close call: intramural oesophageal haematoma presenting with airway compromise.

A close call: intramural oesophageal haematoma presenting with airway compromise.

Computed tomography as a method of substantiating a minimally invasive approach in the treatment of esophageal injuries and their complications

The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.

Intramural Hematoma of Esophagus After Lifting a Heavy Sack of Rice Which Mimicking Cardiovascular Disorder

Intramural Hematoma of Esophagus After Lifting a Heavy Sack of Rice Which Mimicking Cardiovascular Disorder

Mass-Querade: Spontaneous Intramural Oesophageal Haematoma Following Thrombolysis in the Setting of Myocardial Infarction

Spontaneous Intramural Oesophageal Haematoma (IEH) is a rare oesophageal emergency. This report describes the case of a 70-year-old diabetic male, who presented with chest pain and was started on thrombolysis as Electrocardiography (ECG) showed ST elevation Myocardial Infarction (MI). As the patient developed gum bleeding and neck swelling, thrombolysis was stopped. Computed Tomography (CT) showed a non-enhancing mediastinal mass, causing significant extrinsic compression of the distal trachea and a diagnosis of IEH, possibly secondary to thrombolysis was made. Although IEH generally resolves spontaneously with conservative management, the patient remained poorly ventilated despite intubation and expired due to cardiac arrest following failure of resuscitative efforts, eight days after the initial thrombolysis. Several cases of uncomplicated IEH where complete recovery was achieved with conservative treatment are reported in literature; however, there are fewer reports on the poorer outcomes in patients with multiple co-morbidities and co-existent clinical complications.

Intramural submucosal hematoma of esophagus due to anticoagulant treatment

Esophageal intramural submucosal hematoma is a rare and uncommon condition which occurs due to anticoagulant or antiplatelet treatment in the elderly population, or secondary to trauma.A 63-year-old female was presented to emergency with sudden onset hematemesis, back and chest pain left shoulder pain and sweating. She has a history of non-regulated hypertension and new diagnosed atrial fibrillation with using warfarin for a week. Except for high blood pressure, her physical examination was normal with long International Normalized Ratio (INR). For confirming cardiac pathologies (abdominal aortic aneurysm or dissection) echocardiography and intravenous contrast computerized tomography of chest and abdomen was performed Computed Tomography (CT) findings were consistent with an intramural esophageal hematoma. She hospitalized intensive care unit and was controlled regularly with blood tests and vital signs. After decreasing INR, gastroscopy was performed, and findings were consistent with an intramural esophageal hematoma. By hemodynamic stabilization oral intake was starting with fluid. Control esophagogastroscopy was performed to exclude any malignancy underlying hematoma and also showed regression of hematoma. She was recovered with conservative treatment. On the day of the sixteenth, she was discharged. Spontaneously submucosal esophageal hematoma due to anticoagulant or antiplatelet treatment in the elderly patient, is a rarely seen condition. By conservative treatment, most of the cases can be recovered.

SECONDARY SPONTANEOUS INTRAMURAL ESOPHAGEAL HEMATOMA (IEH) FOR CLOPIDOGREL TREATMENT: A CASE REPORT

Giriş: Spontan İntramural Özofagus Hematomu (SIEH), yemek borusunun mukozasının kas tabakalarından ayrılması sonucu ortaya çıkan, nadir görülen bir özofagus hasarı şeklidir. En sık klinik prezentasyon şekilleri ani başlayan göğüs ağrısı, disfaji ve hematemez şeklindedir. Biz burda klopidogrel kullanımına sekonder gelişen, hematemez ile prezente olan SIEH vakası sunmaktayız.Olgu sunumu: 73 yaşında bayan hasta, yoğun bakım ünitesinde serebrovasküler hastalık (SVH) nedeni ile klopidogrel kullanmakta iken hematemezi olması nedeni yapılan endoskopisinde submukozal hematom izlendi. Klopidogrel tedavisi kesilerek takip edildi. Hastanın 1 hafta sonra yapılan kontrol endoskopisinde lineer mukozal düzensizlik dışında patoloji izlenmedi. Tartışma: IEH’ler, özefagus apopleksisi, intramural kanama ve intramural diseksiyon olarak tanımlanmıştır. Kadın cinsiyet, ileri yaş, kanama diyatezi varlığı, antikoagülan antitrombolitik ve antiplatelet ilaçların kullanımı predispozan faktörler arasındadır. Tanıda baryumlu özofagus grafisi, bilgisayarlı tomografi, MRI ve endoskopi kullanılabilmektedir. Endoskopide intramural hipoekoik submukozal lezyon görülebilir. Tedavi konservatif ve destek tedavisi şeklindedir.

Intramural Esophageal Dissection: A Rare Cause of Acute Chest Pain after Percutaneous Coronary Intervention

Intramural esophageal dissection is a condition that typically presents with chest pains and may be associated with hematemesis, odynophagia, and hematemesis. The role of antiplatelet/anticoagulant agents in the development of intramural esophageal hematoma is controversial. The management of intramural esophageal dissection is generally conservative with low mortality and morbidity. The case described here is a 66-year-old woman who presented with chest pains, odynophagia, and dysphagia 1 month after percutaneous coronary intervention while taking ASA (80 mg daily) and clopidogrel (75 mg daily) for dual antiplatelet therapy. The patient was diagnosed as intramural esophageal dissection and underwent successful conservative medical management. The relative contribution of dual antiplatelet therapy with ASA and clopidogrel after percutaneous coronary intervention in this case is, albeit uncertain, a possibility.

Spontaneous intramural esophageal dissection preceded by intramural esophageal hematoma: Report of a case study

Spontaneous intramural esophageal dissection (IED) is a rare disorder characterized by acute symptoms, including chest pain, odynophagia, dysphagia, or hematemesis and remarkable endoscopic or radiographic findings. The pathophysiology is complex and remains poorly understood. Here, we report a 63‐year‐old woman who presented with progressive odynophagia, dysphagia, and weight loss. We diagnosed spontaneous IED with false lumen formation extending to the stomach using ultra‐thin upper endoscopy and water‐soluble contrast esophagogram. Comparing the patient's chronological computed tomographic images before and after symptom onset, we found that spontaneous IED was preceded by an intramural esophageal hematoma. Her symptoms persisted after 3 weeks of conservative treatment. Therefore, combined modalities of endoscopic transection and tissue glue application were given, and her symptoms improved gradually.

A case of intramural esophageal hematoma on triple anticoagulant therapy

A case of intramural esophageal hematoma on triple anticoagulant therapy

Haematemesis and acute dysphagia: oesophagogastroduodenoscopy or CT—which one first?

We present an uncommon case of a patient presenting at the emergency department for severe vomiting, persisting for at least 12 hours, without nausea or abdominal pain. She initially referred...

Spontaneous Intramural Hematoma of the Esophagus: An Unusual Case of Dysphagia and Mediastinal Mass

Introduction: Intramural esophageal hematoma (IEH) is an uncommon but potentially lethal cause of chest pain with accompanying dysphagia. While the majority of cases can be treated with conservative management, we present a case of a spontaneous IEH that later progressed to a symptomatic fibrotic, scared hematoma requiring surgical intervention. Case Report: A 41-year-old female presented to the ED with two days of progressively worsening, severe, non-radiating abdominal pain. She has associated nausea and non-bloody emesis. She denies having heartburn, dysphagia, distention or a change in her bowel habits. Labs show a mild leukocytosis of 10.7; otherwise chemistries, LFTs and lipase are all within normal limits. A KUB shows possible ileus and RUQ ultrasound was normal. CT shows a large mass in the posterior mediastinum with areas of high attenuation, measuring 11.4 x 7.8 x 5.6 in maximal cross sectional diameter (Fig. 1). It extends through the esophageal hiatus with a mass effect on the GE junction, proximal stomach and left atrium. EUS demonstrated an esophageal intramural mass in the wall of the esophagus with associated pericardial effusion. Fine needle aspiration of the mass was significant for gross blood along with inflammatory cells and abundant fibrotic debris (Fig. 2-3). At this time thoracic surgery was consulted to evaluate for potential surgical management of the mass. The patient underwent a left thoracotomy with exploration of the mediastinum where they found a fibrosed hematoma, which was excised. The patient remained in the hospital and was discharged several days later with resolution of symptoms.Figure: CT Chest showing dilated distal esophagus with Intramural Nodule.Figure: EGD showing intramural hematoma.Figure: EUS demonstrating intramural lesion found in the lower third of esophagus appearing to originate from within muscularis propia.Discussion: Intramural esophageal hematoma (IEH) is a rare cause of progressive, chest pain. The majority of cases are due to the use of anticoagulation, trauma, foreign body ingestion, or complications of instrumentation6. While the majority of cases resolve spontaneously, there is scarce literature dictating the management of persistent fibrotic hematomas. Surgical options include both open thoracotomy and video-assisted thorascopic surgery. We present this case in hopes to increase the breadth of knowledge regarding complicated IEH and demonstrate the room for future therapeutic endoscopic interventions opposed to invasive surgery. Finally, we hope to portray a case of a non-resolving IEH to elude on the potential benefit of early reimaging in patients with persistent symptoms.

Balık kılçığına bağlı özofagus intramural hematomu

Intramural hematoma of the esophagus is a rare and benign-course clinical entity, exhibiting chest pain (84%), odynophagia or dysphagia (59%), and hematemesis (56%) as the most common symptoms. There are a few reports of intramural esophageal hematoma caused due to ingestion of a fish bone; here, we report one such very rare case of intramural hematoma of the esophagus caused by fish bone ingestion.

転倒を契機に発症した食道粘膜下血腫の1例

転倒を契機に発症した食道粘膜下血腫の1例

Alendronate: An Unlikely Cause of Intramural Esophageal Hematoma

Introduction: Intramural esophageal hematomas (IEH) are a rare cause of esophageal injury. Precipitating factors of IEH usually include vomiting, straining, iatrogenic causes, and bleeding disorders. We present an unusual case of IEH in a patient who was taking a combination of antiplatelet medications and bisphosphonates. A 78-year-old woman with a history of coronary artery disease status post coronary artery bypass grafts, hypertension, hyperlipidemia, and osteoporosis presented to the ER with burning, retrosternal chest pain and hematemesis which started that morning. Her daily medications included aspirin, clopidogrel, and alendronate. On examination, the patient was hemodynamically stable with a large emesis basin filled with blood. An emergent EGD revealed a raised blue/purple area along the anterior wall of the esophagus, concerning for esophageal hematoma, along with a V-shaped mucosal defect at 23 cm from the incisors oozing blood. An esophagram and CT chest did not reveal signs of esophageal perforation or pneumomediastinum. The patient did well throughout her hospital course and was discharged without any further complications. IEH is defined as a dissection of the esophageal submucosa. It is part of a spectrum of esophageal injuries ranging from local mucosal tears to transmural esophageal rupture. Classic symptoms of IEH include chest pain, dysphagia, and hematemesis. Spontaneous IEH (SIEH) is more likely to occur in patients with bleeding disorders and those on anticoagulation. The cause of our patient’s IEH was probably her two antiplatelet medications and alendronate, which has been known to rarely cause esophageal rupture. On esophagram and CT scan, IEH may appear as abnormal intraluminal/intramural defects. EGD may reveal friable mucosa with a bluish longitudinal hematoma, with or without a mucosal break, similar to what was found in our patient. SIEHs usually resolve within three weeks with conservative management, which explains our patient’s uneventful hospital course and discharge. This case is unique as to our knowledge, it is the first in the literature where a SIEH was associated with a combination of two antiplatelet agents and a bisphosphonate.Figure 1: Esophageal hematoma.

A miniseries of spontaneous intramural esophageal hematoma in hemodialysis patients: A rare cause of dysphagia

Intramural esophageal hematoma (IEH) is an uncommon clinical condition, with a prognosis that is essentially benign. In most cases, a predisposing factor may be seen, with the most common being the history of esophagic instrumentation, food impactions, and thrombocytopenia. We report a miniseries of 3 patients on hemodialysis, who developed IEH. All 3 of them presented with sudden onset and progressively worsening dysphagia and hematemesis. Diagnosis of IEH was established by upper gastrointestinal endoscopy. All patients were managed conservatively, and symptoms of dysphagia and chest pain improved within 6-8 days. Good resolution of hematoma was noted by repeat endoscopy within 2-3 weeks. The reported case of IEH in hemodialysis patients is rare and needs to be identified early when patients present with dysphagia, as anticoagulation during hemodialysis would possibly worsen the clinical condition, the course of which is otherwise benign.

Dissecting intramural hematoma of esophagus after thrombolytic therapy: A case report

Esophageal hematoma is a relatively rare event. We report a case of severe chest pain associated with myocardial infarction and recurrent chest pain after administration of a thrombolytic agent. The chest pain was different from the presenting symptom and accompanied by 2 episodes of hematemesis. Esophageal hematoma was confirmed after endoscopy and computed tomography. Esophageal hematoma is a relatively rare event after thrombolytic therapy.