Intramural Hematoma of the Esophagus
An 83-year-old Caucasian woman with hyperlipemia and previous low back pain was admitted to the hospital because of a sudden onset of sharp interscapular pain after a bout of cough. The patient had been treated for viral bronchitis one week before admission. She reported no dysphagia, odynophagia, hematemesis, fever or weight loss. Her home medication included Mefenacid and simvastatin. Upon admission, vital signs were normal (blood pressure 120/70 mm Hg, heart rate 86/min, temperature 36.3°C, oxygen saturation 97%). Physical examination was unremarkable. Normal electrocardiogram and normal cardiac enzymes ruled out a myocardial infarction. Laboratory tests, including liver enzymes, platelet count and hemostasis, were within normal range, and chest X-ray was normal. A thoracic CT scan ruled out a dissection of the aorta, but revealed an obstructive esophageal mass located in the median and lower part of the esophagus (fig. , fig. ). We performed an upper gastrointestinal endoscopy which showed a large obstructive blue lesion in the esophagus extending from 22 to 36 cm distal from the incisors, suggesting a large intramural hematoma of the esophagus (fig. , fig. ). MRI confirmed the esophageal mass of intermediate signal intensity on T1- and T2-weighted image (fig. ). The patient was managed conservatively with no food or drink intake for 24 h, then allowed a soft diet as she could tolerate, and discharged after 10 days. Repeat endoscopy 14 days later showed that the lesion was healing.