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Case Reports
. 2021 Jul 2;16(9):2474-2477.
doi: 10.1016/j.radcr.2021.05.067. eCollection 2021 Sep.

Life-threatening bleeding from dissecting Intramural Hematoma of Esophagus (IHE) treated by trans arterial embolization

Mina F G Isaac  1 , Chi Long Ho  1 , Sum Leong  1
Affiliations
Case Reports

Life-threatening bleeding from dissecting Intramural Hematoma of Esophagus (IHE) treated by trans arterial embolization

Mina F G Isaac et al. Radiol Case Rep. .

Erratum in

Abstract

Dissecting intramural hematoma of esophagus (DIHE) is an uncommon entity, characterized by accumulation of blood within the esophageal wall and usually managed conservatively. Only in rare circumstances, DIHE is associated with massive life-threatening hemorrhage requiring emergency treatment. We present a case of DIHE associated with cardiovascular collapse and treated by transcatheter arterial embolization. Transcatheter arterial embolization is a rare treatment option for DIHE associated with hemodynamic instability and only a handful of cases have been reported in the literature.

Keywords: DIHE; Dissection; Esophageal; Hematoma; Intramural.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1 –
Fig. 1
Axial (A) arterial and (B) portal venous (PV) phases of contrast enhanced CT reveals a linear streak of contrast in the distal esophageal wall on the arterial phase (arrow head) with subsequent pooling of contrast in the PV phase (arrow). Coronal reformatted image (C) shows a diffusely expanded esophagus by intramural hematoma and almost complete obliteration of the esophageal lumen (arrow).
Fig. 2 –
Fig. 2
Trans-arterial access with superselective catherization (A) of the distal esophageal arterial branch arising from the thoracic aorta (arrow) using a 4-F Shepard Hook catheter followed by 2.2-F Progreat microcatheter. Injection of contrast (B) reveals contrast extravasation from the arterial branch indicating the site of active hemorrhage (arrow). (C) The artery was successfully embolized with PVA particles and several figure of 8 micro coils (arrow). Post-embolization completion angiogram (D) shows cessation of active hemorrhage.
See this image and copyright information in PMC

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