Intramural hematoma of the esophagus presenting as chest pain

Strowd, Roy E.; Agborbesong, Patience; Eapen, Maria; Ervin, Sean

doi:10.1002/jhm.624

Cited by 5 publications

(12 citation statements)

References 14 publications

(14 reference statements)

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“…Acute mucosal injury of the esophagus can manifest as Mallory-Weiss syndrome, Boerhaave syndrome, or IHE, with IHE being the rarest of these conditions [2]. IHE is classified as traumatic IHE or spontaneous IHE [1].…”

Section: Discussionmentioning

confidence: 99%

“…Antiplatelet therapy is also thought to increase the risk of IHE [1–5]. Symptoms of IHE include acute retrosternal pain, odynophagia or dysphagia, hematemesis, and heartburn [2,4], the characteristic clinical triad being acute retrosternal pain, odynophagia or dysphagia, and hematemesis. Only 35% of patients with IHE have all 3 of these symptoms, whereas 99% have at least 1 of these symptoms [2].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms of IHE include acute retrosternal pain, odynophagia or dysphagia, hematemesis, and heartburn [2,4], the characteristic clinical triad being acute retrosternal pain, odynophagia or dysphagia, and hematemesis. Only 35% of patients with IHE have all 3 of these symptoms, whereas 99% have at least 1 of these symptoms [2]. The amount of hematemesis tends to be smaller than what is typically associated with Mallory-Weiss syndrome [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as during endoscopic surgery, or occur spontaneously such as in individuals with coagulation disorders or individuals who are receiving antiplatelet therapy [1]. The characteristic clinical triad of manifestations of IHE comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis [2]. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

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Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Yamada

Motomura²,

Hiraoka³

et al. 2019

Am J Case Rep

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Patient: Male, 84 Final Diagnosis: Intramural hematoma of esophagus Symptoms: Chest pain • hematemesis Medication: — Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology Objective: Diagnostic/therapeutic accidents Background: Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. Case Report: An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. Conclusions: Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Yamada

Motomura²,

Hiraoka³

et al. 2019

Am J Case Rep

View full text Add to dashboard Cite

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“…The prognosis is excellent with conservative treatment [6]. Intramural hematoma of the esophagus can also be misdiagnosed as other digestive pathologies such as perforated peptic ulcer and pancreatitis [6], cardiac or vascular diseases such as ischemic heart disease, dissection or aneurysm rupture of the thoracic aorta [3] or pulmonary embolism [9], or pulmonary lesions such as pneumothorax [10]. …”

Section: Discussionmentioning

confidence: 99%

Intramural Hematoma of the Esophagus

Cao

Reny

Lanthier

et al. 2012

Case Rep Gastroenterol

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We report the case of a patient with an intramural hematoma of the esophagus. This rare condition is more common in elderly women and can be misdiagnosed as cardiovascular or other digestive emergent disease. The classical clinical triad includes chest pain, sudden dysphagia or odynophagia and minor hematemesis. Known precipitating factors are Valsalva maneuver, blunt, direct or iatrogenic injuries, but spontaneous cases have also been described. Chest imaging including computed tomography or magnetic resonance imaging as well as upper gastrointestinal endoscopy are useful tools for diagnosis. The treatment is conservative and the prognosis usually excellent with complete resolution within a few weeks.

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Histopathological Changes in the Gastrointestinal Tract Due to Drugs

et al. 2013

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Abnormalities of the gastrointestinal (GI) tract due to drugs (AGIDs) are numerous and have significant impact. The aim of this narrative review is to help the practicing surgical pathologist recognize selected AGIDs. The adverse drug effects presented were chosen with an emphasis on recent and significant pathological and clinical contributions. The selection was based on a thorough review of the PUBMED-based literature and on the authors' opinions and experience. In the first part of the review, diagnostic abnormalities due to crystals (eg, iron, biphosphonates, nonsystemic drugs), mitosis arresting drugs (colchicine, taxanes), and biological agents, especially ipilimumab, are discussed. Some AGIDs' histopathologic features can be easily recognized. It is however the clinical correlation that in many cases of AGIDs will provide the necessary support for a drug effect diagnosis. The identification of AGIDs requires heightened awareness of the medical team in which close collaboration of pathologists and clinicians cannot be overemphasized.

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Intramural hematoma of the esophagus presenting as chest pain

Cited by 5 publications

References 14 publications

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Nasogastric Tubes Can Cause Intramural Hematoma of the Esophagus

Intramural Hematoma of the Esophagus

Histopathological Changes in the Gastrointestinal Tract Due to Drugs

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