Texas Tech University Health Sciences Center dearborn, MI
Nooraldin Merza, MD1, Sameer Prakash, DO1, Omar Bazzaz, MD2, Mazin Saadaldin, MD1, Tarek Naguib, MD1; 1Texas Tech University Health Sciences Center, Amarillo, TX; 2Amarillo VA Care System, Amarillo, TX
Introduction: Esophageal wall injuries may present as a tear (Mallory-Weiss tear), a rupture (Boerhaave syndrome) or, more rarely, as an intra esophageal hematoma (IEH), either spontaneously e.g. due to bleeding diathesis or after trauma e.g. from vomiting or instrumentation. The usual presentation is that of a sudden onset of retrosternal chest pain and hematemesis. We present a unique case of a gentleman with influenza A who had IEH, but presented with hemoptysis rather
Methods: A 95year old male WWII veteran with history of hypertension and atrial fibrillation, presented with hemoptysis after three days of dry cough and flu-like symptoms. His medications included lisinopril, metoprolol and apixaban. His vital signs were normal and examination was unremarkable. Liver enzymes, platelet count, PT, PTT, INR, and Hb were all normal. He tested positive for Influenza A. Thoracic CT scan revealed a non-obstructive esophageal mass, described as a transmural thickening associated with hemoglobin dropped from 12 to 8.2 gm/dL. EGD showed a large non obstructive blue lesion in the esophagus extending from the vocal cords level distally suggesting a large intramural hematoma of the esophagus. MRI confirmed the esophageal mass of intermediate signal intensity on T1- and T2-weighted image. Both apixaban and oral intake were withheld. A day later, soft feeding was instituted. Repeat endoscopy and CT of the thorax 15 days later showed that the lesion was healing well Discussion: IEH is an uncommon form of an esophageal injury. It has been described as esophageal apoplexy, intramural hemorrhage, and intramural dissection. It may occur following an esophageal dilation procedure. However, it can also present spontaneously in persons on anticoagulation. The most common presenting symptoms are chest pain and hematemesis. However the triad of chest pain, dysphagia and hematemesis is present in only 35% of the individuals afflicted by IEH. Other symptoms may include epigastric pain and odynophagia. The condition usually has a benign course and resolves within a few weeks of conservative management. Our patient did well with conservative management.
CT scan at the initial presentation showing a mass in the esophagus
Repeated CT scan few weeks later, showing the resolution of the Intra-esophageal hemorrhage( IEH)
Disclosures: Nooraldin Merza indicated no relevant financial relationships. Sameer Prakash indicated no relevant financial relationships. Omar Bazzaz indicated no relevant financial relationships. Mazin Saadaldin indicated no relevant financial relationships. Tarek Naguib indicated no relevant financial relationships.