Korean Circ J.  2007 Dec;37(12):666-670. 10.4070/kcj.2007.37.12.666.

Transthoracic Echocardiographic Detection, Differential Diagnosis, and Follow-Up of Esophageal Hematoma

• Im E
• Shim CY
• Hwang HJ
• Lee SY
• Yang WI
• Jung YS
• Kim HR
• Choi EY
• Ha JW
• Chung N

• KMID: 2227044
• DOI: http://doi.org/10.4070/kcj.2007.37.12.666

Abstract

Esophageal hematoma is a rare form of esophageal injury. It may occur spontaneously, or in association with direct esophageal damage or a bleeding diathesis. Endoscopy and computed tomography are generally necessary for the establishment of a diagnosis. In this report, we present a case of esophageal hematoma that was discovered via a bedside transthoracic echocardiography. The echocardiography was conducted to evaluate an unexplained shock in a critically ill-patient. After conservative treatment, complete resolution of the esophageal hematoma was documented by a 7-day short-term follow-up of bedside transthoracic echocardiography. To the best of our knowledge, this is the first case report regarding transthoracic echocardiographic detection, differential diagnosis, and follow-up for esophageal hematoma.

Keyword

Hematoma; Transthoracic echocardiography

MeSH Terms

Diagnosis
Diagnosis, Differential*
Disease Susceptibility
Echocardiography*
Endoscopy
Follow-Up Studies*
Hematoma*
Hemorrhage
Shock

Figure

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  Fig. 1 Chest radiography. A: after heartburn and dyspnea, chest radiography evidenced pneumonic consolidation in the left lower lung field. B: after 4 days when the patient developed severe dyspnea and generalized edema, chest radiography revealed diffuse bilateral pulmonary edema.

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  Fig. 2 Upper endoscopy showed the esophagus with mild esophagitis. Friable mucosal change without active bleeding was noted on the distal esophagus. Multiple whitish round flat lesions were also noted from the mid to distal esophagus. However, no protruding lesions were observed.

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  Fig. 3 The bedside TTE revealing the esophageal hematoma and its complete resolution. Previous bedside TTE evidenced no esophageal mass (A and B). However, in the follow-up bedside TTE, the parasternal long axis view showed the esophageal hematoma (arrow) located at the posterior side of the LA (C). The apical 4 chamber view showed the esophageal hematoma compressing the LA (D). The next follow-up bedside TTE demonstrated the complete resolution of the hematoma (E and F). TTE: transthoracic echocardiography, LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle, Ao: aorta, H: esophageal hematoma.

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  Fig. 4 Chest CT scan revealed the mass compressing the LA. Chest CT verified that the mass is an esophageal hematoma (arrow). CT: computed tomography, LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle, H: esophageal hematoma.

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