Korean J Gastroenterol.  2017 Apr;69(4):239-242. 10.4166/kjg.2017.69.4.239.

A Case of Intramural Hematoma of the Esophagus Mimicking Acute Coronary Syndrome

• Ryu DG
• Choi CW
• Kang DH
• Kim HW
• Jeong DI
• Kim WC
• Shin JG
• Lim TW

• KMID: 2383402
• DOI: http://doi.org/10.4166/kjg.2017.69.4.239

Abstract

Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed.

Keyword

Hematoma; Esophagus; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome*
Chest Pain
Coronary Angiography
Coronary Vessels
Deglutition Disorders
Eating
Endoscopy
Esophagus*
Hematemesis
Hematoma*
Humans
Middle Aged
Platelet Aggregation Inhibitors
Stents
Thorax
Ulcer
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 Chest computed tomography findings. Diffuse wall thickening from the middle esophagus (A) to the cardia of the stomach (B) is observed, with eccentric thickening mainly in the medial and posterior aspect without contrast enhancement.

• 

  Fig. 2 Endoscopic findings. From the middle esophagus, a long red purple hematoma covered with some ulcer was observed (A), which was passed from the gastroesophageal junction to the cardia of the stomach (B). Seven days later, the hematoma has disappeared and a longitudinal ulcer with whitish plaques is observed matching the site. Mid esophagus (C) and the cardia of the stomach (D).

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  Fig. 3 Histopathologic finding of the esophageal wall. Inflammatory cells and normal glands are observed and there are no findings such as dysplasia (H&E, ×100).

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  Fig. 4 Endoscopic findings of the esophagus after 8 weeks. The hematomas and ulcers have disappeared.

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