Intramural Esophageal Hematoma Secondary to Food Ingestion

Abstract

Intramural esophageal hematoma (IEH) is a rare cause of submucosal esophageal bleeding and it is on the spectrum of esophageal wall injury along with mucosal tears (Mallory-Weiss syndrome) and full thickness perforation (Boerhaave's syndrome). Its risk factors include coagulopathy, trauma (foreign body ingestion or esophageal instrumentation) or it can happen spontaneously. It presents with a triad of chest pain, dysphagia, and hematemesis; however, the triad is only present in 35% of patients. We are presenting a case of IEH secondary to food ingestion that was managed successfully by conservative measures.

Keywords: esophageal hematoma; esophageal wall injury; food ingestion.

Figure 1. Computed tomography (CT) thorax with oral and intravenous (IV) contrast showing esophageal luminal narrowing at the distal third (yellow arrowhead) with mural thickening and a soft tissue density extending to the gastroesophageal junction (yellow arrow)

Figure 2. Computed tomography (CT) abdomen with oral and intravenous (IV) contrast showing hyperdense oral contrast layering (yellow arrowhead) over a rounded, well-circumscribed structure in the visualized distal esophagus (yellow arrow) concerning for an intramural esophageal hematoma

Figure 3. Esophagogastroduodenoscopy showing bluish discoloration at the distal third of the esophagus (black arrow) and a non-bleeding ulcer at the gastroesophageal junction (yellow arrowheads)