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Spontaneous esophageal hematoma: Endoscopic follow up

Intramural esophageal hematoma is a rare form of esophageal injury. It may occur spontaneously (more rare) or may be secondary to sclerosis of varicose veins, esophageal dilatation, food impaction or coagulopathy. It can present itself as a sudden pain retrosternal or dorsal, as hematemesis, dysphagia or odynophagia. Despite the exuberant presentation, most patients have resolution with conservative measures. Esophagoduodenoscopy is the diagnostic modality, and it may show a mass with a blue-red appearance. Biopsy of such lesions must be avoided because of the obvious potential risk of bleeding. The usual mode of treatment is watchful waiting, and most patients will do better without any intervention. We present the case of a female aged 51 years without past medical history and taking no medications who presented with acute dysphagia of solid foods. She denied any abdominal pain or fever, nor any previous history of dysphagia or recent use of aspirin. Examination and standard laboratory tests, including coagulation parameters and platelet counts, were within normal ranges. She subsequently had esophagoduodenoscopy, which showed in the upper esophagus a longitudinal red-blue elevation of 4 cm with no evidence of foreign body or other changes (Fig. 1). It was deemed to be an esophageal hematoma. The patient was further submitted for computed tomography of the chest, which revealed no other mediastinal or aortic lesion beyond an eccentric, welldefined intramural esophageal mass corresponding to the esophageal hematoma that was previously seen at endoscopy. The patient did well and was subsequently discharged after documented resolution on endoscopy (Fig. 2).