Spontaneous Intramural Hematoma of the Esophagus

Ajay Chawla; Michael H. Blume; Jerald Insel

doi:10.7326/0003-4819-137-1-200207020-00027

Letters |2 July 2002

Spontaneous Intramural Hematoma of the Esophagus

Ajay Chawla, MD; Michael H. Blume, MD; Jerald Insel, MD

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TO THE EDITOR:

Spontaneous intramural hematoma of the esophagus is an uncommon cause of acute odynophagia. It can result in chest pain, dysphagia, and hematemesis (1). We report a case of a man with hemophilia and partial factor VIII deficiency who presented with sudden onset of acute odynophagia and substernal chest pain radiating to the anterior chest and shoulder. The patient did not report a history of emesis, trauma, ingestion of nonsteroidal anti-inflammatory drugs, or gastrointestinal bleeding episodes. His vital signs were stable, and results of liver and kidney function tests were normal. His initial prothrombin time was 44 seconds; international normalized ratio was 1.2. Computed tomography of the chest (Figure, top) and subsequent endoscopy showed proximal esophageal obstruction due to intramural hematoma. The patient was treated with rVIII factor infusion. Repeated computed tomography (Figure, bottom) and endoscopy after 7 days showed resolution of the hematoma. Symptoms also resolved. Biopsy of the esophagus showed no malignant disease but indicated extensive hemorrhage. The patient was subsequently discharged from the hospital in stable condition.

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2002 American College of Physicians

Letters |2 July 2002

Spontaneous Intramural Hematoma of the Esophagus

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Letters |2 July 2002

Spontaneous Intramural Hematoma of the Esophagus

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