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Intramural hematoma of the esophagus: a pictorial essay

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Abstract

Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory–Weiss tear and Boerhaave’s syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory–Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients maybe treated conservatively with good outcome.

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References

  1. Kerr WF (1980) Spontaneous intramural rupture and intramural haematoma of the oesophagus. Thorax 35:890–897

    Article  PubMed  CAS  Google Scholar 

  2. Joffe N, Millan VG (1970) Postemetic dissecting intramural hematoma of the esophagus. Radiology 95:379–380

    PubMed  CAS  Google Scholar 

  3. Modi P, Edwards A, Fox B, Rahamim J (2005) Dissecting intramural haematoma of the oesophagus. Eur J Cardiothorac Surg 27:171–173

    Article  PubMed  Google Scholar 

  4. Mion F, Bernard G, Valette PJ, Lambert R (1994) Spontaneous esophageal hematoma: diagnostic contribution of echoendoscopy. Gastrointest Endosc 40:503–505

    Article  PubMed  CAS  Google Scholar 

  5. Jotte RS (1991) Esophageal apoplexy: case report, review, and comparison with other esophageal disorders. J Emerg Med 9:437–443

    Article  PubMed  CAS  Google Scholar 

  6. Longstreth GF (1990) Esophageal tear caused by a tortilla chip. N Engl J Med 322:1399–1400

    PubMed  CAS  Google Scholar 

  7. Klygis LM (1992) Esophageal hematoma and tear from a taco shell impaction. Gastrointest Endosc 38:100

    PubMed  CAS  Google Scholar 

  8. Piccione PR, Winkler WP, Baer JW, Kotler DP (1987) Pill-induced intramural esophageal hematoma. JAMA 257:929

    Article  PubMed  CAS  Google Scholar 

  9. Sanaka M, Kuyama Y, Hirama S, Nagayama R, Tanaka H, Yamanaka M (1998) Spontaneous intramural hematoma localized in the proximal esophagus: truly “spontaneous”? J Clin Gastroenterol 27:265–266

    Article  PubMed  CAS  Google Scholar 

  10. Shay SS, Berendson RA, Johnson LF (1981) Esophageal hematoma. Four new cases, a review, and proposed etiology. Dig Dis Sci 26:1019–1024

    Article  PubMed  CAS  Google Scholar 

  11. Yeoh NT, McNicholas T, Rothwell-Jackson RL, Goldstraw P (1985) Intramural rupture and intramural haematoma of the oesophagus. Br J Surg 72:958–960

    Article  PubMed  CAS  Google Scholar 

  12. Ashman FC, Hill MC, Saba GP, Diaconis JN (1978) Esophageal hematoma associated with thrombocytopenia. Gastrointest Radiol 3:115–118

    Article  PubMed  CAS  Google Scholar 

  13. Lowman RM, Goldman R, Stern H (1969) The roentgen aspects of intramural dissection of the esophagus. The mucosal stripe sign. Radiology 93:1329–1331

    PubMed  CAS  Google Scholar 

  14. Folan RD, Smith RE, Head JM (1992) Esophageal hematoma and tear requiring emergency surgical intervention. A case report and literature review. Dig Dis Sci 37:1918–1921

    Article  PubMed  CAS  Google Scholar 

  15. Steadman C, Kerlin P, Crimmins F et al (1990) Spontaneous intramural rupture of the oesophagus. Gut 31:845–849

    Article  PubMed  CAS  Google Scholar 

  16. Huddy J, Kotecha A, Dussek J, McNair A (2005) Dissecting intramural hematoma of the esophagus after thrombolysis for myocardial infarction. Gastrointest Endosc 61:340–343

    Article  PubMed  Google Scholar 

  17. Jishi F, Sissons CE, Silverstone EJ, Coakley JF, Fraser F (1992) Oesophageal dissection after thrombolytic treatment for myocardial infarction. Thorax 47:835–836

    PubMed  CAS  Google Scholar 

  18. Hiller N, Zagal I, Hadas-Halpern I (1999) Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol 94:2282–2284

    Article  PubMed  CAS  Google Scholar 

  19. Dallemand S, Amorosa JK, Morris DW, Iyer S (1983) Intramural hematomas of the esophagus. Gastrointest Radiol 8:7–9

    Article  PubMed  CAS  Google Scholar 

  20. Bradley JL, Han SY (1979) Intramural hematoma (incomplete perforation) of the esophagus associated with esophageal dilatation. Radiology 130:59–62

    PubMed  CAS  Google Scholar 

  21. Jones DB, Frost RA, Goodacre RL (1986) Intramural hematoma of the esophagus–a complication of endoscopic injection sclerotherapy. Gastrointest Endosc 32:239–240

    PubMed  CAS  Google Scholar 

  22. Yen HH, Soon MS, Chen YY (2005) Esophageal intramural hematoma: an unusual complication of endoscopic biopsy. Gastrointest Endosc 62:161–163

    Article  PubMed  Google Scholar 

  23. de Vries RA, Kremer-Schneider MM, Otten MH (1991) Intramural hematoma of the esophagus caused by minor head injury 6 hours previously. Gastrointest Radiol 16:283–285

    Article  PubMed  Google Scholar 

  24. Williams B (1957) Case report; oesophageal laceration following remote trauma. Br J Radiol 30:666–668

    PubMed  CAS  Google Scholar 

  25. Rozec B, Rigal JC, Leteurnier Y, Lebert C, Blanloeil Y (1998) Post-traumatic hematoma of the esophagus. Ann Fr Anesth Reanim 17:1160–1163

    PubMed  CAS  Google Scholar 

  26. Ketai L, Brandt MM, Schermer C (2000) Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging 15:120–127

    Article  PubMed  CAS  Google Scholar 

  27. Meulman N, Evans J, Watson A (1994) Spontaneous intramural haematoma of the oesophagus: a report of three cases and review of the literature. Aust N Z J Surg 64:190–193

    PubMed  CAS  Google Scholar 

  28. Ackert JJ, Sherman A, Lustbader IJ, McCauley DI (1989) Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol 84:1325–1328

    PubMed  CAS  Google Scholar 

  29. Hollander JE, Quick G (1991) Aortoesophageal fistula: a comprehensive review of the literature. Am J Med 91:279–287

    Article  PubMed  CAS  Google Scholar 

  30. Cullen SN, McIntyre AS (2000) Dissecting intramural haematoma of the oesophagus. Eur J Gastroenterol Hepatol 12:1151–1162

    PubMed  CAS  Google Scholar 

  31. Hagel J, Bicknell SG, Haniak W (2007) Imaging management of spontaneous giant esophageal intramural hematoma. Can Assoc Radiol J 58:76–78

    PubMed  Google Scholar 

  32. Michel L (1980) Mallory–Weiss syndrome. Evolution of diagnostic and therapeutic patterns over two decades. Ann Surg 192:716–721

    Article  PubMed  CAS  Google Scholar 

  33. Enns R, Brown JA, Halparin L (2000) Intramural esophageal hematoma: a diagnostic dilemma. Gastrointest Endosc 51:757–759

    Article  PubMed  CAS  Google Scholar 

  34. Maher MM, Murphy J, Dervan P, O’Connell D (1998) Aorto-oesophageal fistula presenting as a submucosal oesophageal haematoma. Br J Radiol 71:972–974

    PubMed  CAS  Google Scholar 

  35. Fadoo F, Ruiz DE, Dawn SK, Webb WR, Gotway MB (2004) Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture. AJR Am J Roentgenol 182:1177–1179

    PubMed  Google Scholar 

  36. Panebianco V, Grazhdani H, Iafrate F et al (2006) 3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging? Eur Radiol 16:414–421

    Article  PubMed  CAS  Google Scholar 

  37. Kim SH, Lee JM, Han JK et al (2006) Three-dimensional MDCT imaging and CT esophagography for evaluation of esophageal tumors: preliminary study. Eur Radiol 16:2418–2426

    Article  PubMed  Google Scholar 

  38. Ba-Ssalamah A, Zacherl J, Noebauer-Huhmann IM et al (2007) Dedicated multi-detector CT of the esophagus: spectrum of diseases. Abdom Imaging (in press)

  39. Umeoka S, Koyama T, Togashi K et al (2006) Esophageal cancer: evaluation with triple-phase dynamic CT–initial experience. Radiology 239:777–783

    Article  PubMed  Google Scholar 

  40. Meininger M, Bains M, Yusuf S, Gerdes H (2002) Esophageal intramural hematoma: a painful condition that may mimic an esophageal mass. Gastrointest Endosc 56:767–770

    Article  PubMed  Google Scholar 

  41. Geller A, Gostout CJ (1998) Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment. Mayo Clin Proc 73:342–345

    PubMed  CAS  Google Scholar 

  42. Swensen SJ, McLeod RA, Stephens DH (1984) CT of extracranial hemorrhage and hematomas. AJR Am J Roentgenol 143:907–912

    PubMed  CAS  Google Scholar 

  43. Wolverson MK, Crepps LF, Sundaram M, Heiberg E, Vas WG, Shields JB (1983) Hyperdensity of recent hemorrhage at body computed tomography: incidence and morphologic variation. Radiology 148:779–784

    PubMed  CAS  Google Scholar 

  44. Jang KM, Lee KS, Lee SJ et al (2002) The spectrum of benign esophageal lesions: imaging findings. Korean J Radiol 3:199–210

    Article  PubMed  Google Scholar 

  45. Pezzulli FA, Aronson D, Goldberg N (1989) Computed tomography of mediastinal hematoma secondary to unusual esophageal laceration: a Boerhaave variant. J Comput Assist Tomogr 13:129–131

    Article  PubMed  CAS  Google Scholar 

  46. Lee KS, Kim IY, Kim PN (1991) Dissecting intramural hematoma of the esophagus in Boerhaave syndrome: CT findings. AJR Am J Roentgenol 157:197–198

    PubMed  CAS  Google Scholar 

  47. Demos TC, Okrent DH, Studlo JD, Flisak ME (1986) Spontaneous esophageal hematoma diagnosed by computed tomography. J Comput Assist Tomogr 10:133–135

    Article  PubMed  CAS  Google Scholar 

  48. Schweiger F, Depew WT (1987) Spontaneous intramural esophageal hematoma. Diagnosis by CT scanning. J Clin Gastroenterol 9:546–548

    Article  PubMed  CAS  Google Scholar 

  49. Ghanem N, Altehoefer C, Springer O et al (2003) Radiological findings in Boerhaave’s syndrome. Emerg Radiol 10:8–13

    PubMed  Google Scholar 

  50. Skillington PD, Matar KS, Gardner MA, Parkes RP, Cole PH (1989) Intramural haematoma of the oesophagus complicated by perforation. Aust N Z J Surg 59:430–432

    Article  PubMed  CAS  Google Scholar 

  51. Murata N, Kuroda T, Fujino S, Murata M, Takagi S, Seki M (1991) Submucosal dissection of the esophagus: a case report. Endoscopy 23:95–97

    PubMed  CAS  Google Scholar 

  52. Kise Y, Suzuki R, Shimada H et al (2001) Idiopathic submucosal hematoma of esophagus complicated by dissecting aneurysm, followed-up endoscopically during conservative treatment. Endoscopy 33:374–378

    Article  PubMed  CAS  Google Scholar 

  53. Kamphuis AG, Baur CH, Freling NJ (1995) Intramural hematoma of the esophagus: appearance on magnetic resonance imaging. Magn Reson Imaging 13:1037–1042

    Article  PubMed  CAS  Google Scholar 

  54. Picus D, Balfe DM, Koehler RE, Roper CL, Owen JW (1983) Computed tomography in the staging of esophageal carcinoma. Radiology 146:433–438

    PubMed  CAS  Google Scholar 

  55. Goldstone J, Cunningham CC (1990) Diagnosis, treatment and prevention of aorto-enteric fistulas. Acta Chir Scand Suppl 555:165–172

    PubMed  CAS  Google Scholar 

  56. Barone JE, Robilotti JG, Comer JV (1980) Conservative treatment of spontaneous intramural perforation (or intramural hematoma) of the esophagus. Am J Gastroenterol 74:165–167

    PubMed  CAS  Google Scholar 

  57. Biagi G, Cappelli G, Propersi L, Grossi A (1983) Spontaneous intramural haematoma of the oesophagus. Thorax 38:394–395

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, The University of Texas Health Science Center at San Antonio, Mail Code 7800, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA

    Carlos S. Restrepo & Daniel Ocazionez

  2. Department of Radiology, University of Vermont College of Medicine, 111 Colchester Ave., Burlington, VT, 05401, USA

    Diego F. Lemos

  3. Department of Radiology, LSU Health Science Center, 1542 Tulane Ave. Room 308, New Orleans, LA, 70112, USA

    Rogelio Moncada & Carlos R. Gimenez

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  1. Carlos S. Restrepo
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  2. Diego F. Lemos
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  3. Daniel Ocazionez
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  4. Rogelio Moncada
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  5. Carlos R. Gimenez
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Correspondence to Carlos S. Restrepo.

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Restrepo, C.S., Lemos, D.F., Ocazionez, D. et al. Intramural hematoma of the esophagus: a pictorial essay. Emerg Radiol 15, 13–22 (2008). https://doi.org/10.1007/s10140-007-0675-0

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  • DOI: https://doi.org/10.1007/s10140-007-0675-0

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