Spontaneous Intramural Esophageal Hematoma Secondary to Thrombolysis in the Setting of Pulmonary Embolism

Abstract

Intramural hematoma of the esophagus (IHE) represents a rare condition on the spectrum of esophageal injuries. The most common symptoms are hematemesis, epigastric pain or retrosternal chest pains, odynophagia, and dysphagia. Early recognition of IHE is important as it may mimic other diseases such as myocardial infarction, pulmonary embolism, Mallory–Weiss tears, Boerhaave’s syndrome, ruptured aortic aneurysms, and aortic dissection. Computed tomography is the preferred investigation method, and treatment is usually conservative. We herein present 2 cases of IHE associated with catheter-directed thrombolysis in the setting of pulmonary embolism.

Embolization of the esophageal branch of intercostal artery for treatment of spontaneous intramural hematoma of the esophagus: a case description

“…Although there is no definite conclusion regarding the etiology of SIHE, it can be classified into the following categories ( 3 , 12 , 13 ): (I) esophageal injury; (II) a rapid rise of intraesophageal pressure; (III) iatrogenic injury, involving improper gastroscopy, retention of the gastric tube and small intestinal nutrition tube, etc; (IV) abnormal coagulation function; (V) related diseases, such as aortoesophageal fistula, esophageal cancer, esophageal hiatal hernia, etc. ; (VI) special treatment, such as myocardial infarction thrombolysis, atrial fibrillation ablation, hemodialysis, etc; (VII) idiopathic disease without identifiable cause; and (VIII) spontaneous emergence (i.e., occurring naturally).…”

Treatment of Esophageal Hematoma After Left Atrial Appendage Occlusion: A Case Report

“…The causes of non-iatrogenic esophageal hematoma include foreign body ingestion, esophageal malignancy, trauma, or other esophageal pathologies such as esophagitis. According to previous case reports, iatrogenic esophageal hematoma may occur after AF ablation procedures ( 3 ), upper gastrointestinal endoscopy, or thrombolytic therapy for pulmonary embolism that leads to abnormalities in hemostasis ( 4 ). Although it typically has a good prognosis, with resolution of the symptoms within weeks, esophageal hematoma can result in nearly complete occlusion of the gastric lumen, or even compression of the adjacent cardiac chambers and airway, causing dyspnea or pulmonary atelectasis.…”