Oesophageal haematoma masquerading as cardiac ischaemia

Furtado, Ruelan; Beasley, William; Mastrocostas, Katerina; Falk, Gregory L.

doi:10.1111/ans.12562

Cited by 1 publication

(2 citation statements)

References 7 publications

(10 reference statements)

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“…Iatrogenic causes such as nasogastric tube insertion, OGD, trans-oesophageal echocardiography have all been documented [8] , [9] , [10] . This pathology has known to occur in the presence of coagulopathic disorders or patients who are anticoagulated [11] , [12] , [13] . In a few reported cases IOD can occur spontaneously, and no known cause can be found [4] , [8] , [14] .…”

Section: Discussionmentioning

confidence: 99%

“…Medications such as warfarin, clopidogrel, and systemic thrombolysis for treatment of acute coronary syndrome have been reported to cause oesophageal haematomas, in some cases in the absence of vomiting, cough, or oesophageal instrumentation. There have been no reported cases of this pathology occurring with the use of fish oil alone [11] , [12] , [13] .…”

Section: Discussionmentioning

confidence: 99%

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Intramural oesophageal dissection as an unusual presentation of chest pain: A case report

Mizumoto¹,

Rooyen²

2015

Annals of Medicine &Amp; Surgery

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IntroductionIntramural oesophageal dissection (IOD) is a rare clinical condition and there is a paucity of information regarding the appropriate diagnosis and management. It is described as bleeding in the submucosal plane of the oesophagus, and has various documented causes.Presentation of caseWe report a case of a 73 year old female who developed IOD. She presented with severe chest pain. Subsequent imaging revealed IOD and haematoma formation. This was confirmed on oesophagogastroduodenoscopy (OGD). She was on a bisphosphonate for her osteoporosis, as well as having age-related dysmotility of her oesophagus on manometric studies. She was also taking fish oil. Treatment was conservative and the patient was discharged with proton pump inhibitors and follow up.DiscussionSpontaneous haematoma formation and IOD resulted likely from a combination of the anticoagulant effect of fish oil and oesophageal dysmotility. Bisphosphonates also have some well documented gastrointestinal side effects involving mucosal damage. The possibility that the concurrent use of bisphosphonate led to a pre-existing ulcer which could have contributed to the development of IOD in this patient should be considered.Conclusionspontaneous IOD can occur in elderly patients who are anticoagulated. Fish oil has not been previously reported as having an association with IOD. This is the first known reported case of spontaneous IOD occurring in association with concurrent use of a bisphosphonate and fish oil. IOD is a rare disorder, and any anticoagulated patients presenting with severe chest pain may need careful investigation prior to definitive management.

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