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Esophageal Hematoma Clinical Presentation

  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Julian Katz, MD  more...
Updated: Dec 15, 2014


See the list below:

  • Spontaneous intramural hematoma of the esophagus usually presents initially with severe retrosternal or epigastric pain with or without radiation. The pain is described as abrupt in onset and is aggravated by swallowing.
  • In one meta-analysis, 32% of patients presented with the triad of chest pain, hematemesis, and dysphagia; 99% of patients had at least one of these symptoms.


A complete and thorough physical examination should be performed.

  • Asking a patient to take a sip of water as part of the general examination may help to unmask symptoms of dysphagia. This may help toward distinguishing between cardiac chest pain and an esophageal disorder causing chest pain.
  • Palpation looking for the presence of crepitus (suggesting the presence of air under the skin) along the neck, back, and chest can help to rule in or out the presence of an esophageal perforation.


Esophageal hematomas typically occur in the setting of vomiting or retching, although spontaneous hematomas (more commonly in patients with bleeding disorders) may also occur.

  • Precipitating or predisposing factors to esophageal hematoma include the following:
    • Coagulopathies, such as hemophilia, or treatment with anticoagulants or aspirin
    • Instrumentation, such as with endoscopy or variceal sclerotherapy
    • Foreign body ingestion
    • Chest trauma
    • Food-induced injury, as a result of abrasive trauma by foodstuffs
    • Cardioversion and subsequent anticoagulation
    • Toxin ingestion
    • Endotracheal intubation

One study reported on 3 patients who developed intramural esophageal hematoma while on hemodialysis. Onset was sudden and characterized by progressively worsening dysphagia and hematemesis. The patients were successfully managed conservatively, with the hematoma resolving within 2-3 weeks.[17]

A prospective study by Kumar et al indicated that transesophageal echocardiography (TEE)-guided atrial fibrillation (AF) is, in rare cases, associated with esophageal hematoma, a cause of significant morbidity. In the study, which involved 1110 TEE-guided AF ablation procedures, the procedural incidence of esophageal hematoma was 0.27% (three procedures). The patients’ predominant symptoms, which arose within 12 hours of the procedure, were hoarseness, odynophagia, and regurgitation. Long-term sequelae of esophageal hematoma included the formation of esophageal strictures, as well as persistent esophageal dysmotility (in association with midesophageal hematoma) and hoarseness caused by vocal cord paralysis (in association with upper esophageal hematoma).[18]

Contributor Information and Disclosures

Jennifer Lynn Bonheur, MD Attending Physician, Division of Gastroenterology, Lenox Hill Hospital

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy, New York Academy of Sciences, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, New York Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Klaus Radebold, MD, PhD Former Research Associate, Department of Surgery, Yale University School of Medicine

Disclosure: Nothing to disclose.

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