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Dissecting intramural hematoma of the esophagus.

A 63-year-old woman, with no previous medical history, presented to the emergency room with severe retrosternal chest pain and shortness of breath. Her d-dimer level was raised at 1100 ng/mL. A pulmonary embolus was suspected, and she was administered a therapeutic dose of low molecular weight heparin. A computed tomography of thorax revealed a dilated esophagus and a dissecting intramural hematoma throughout its length (Figs. 1 and 2). On further questioning, she admitted that in the past, she had experienced difficulty swallowing, describing it as a “slow swallow” over 20 years. Prior to her acute presentation, she had taken a glucosamine tablet that lodged in her esophagus and precipitated retching. She was