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Esophageal Hematoma Workup

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

Laboratory Studies

See the list below:

  • The laboratory workup should include hemoglobin concentration and coagulation profile with platelet count.
  • Cardiac enzymes and troponin levels should be drawn to exclude a cardiac cause for the patient's chest pain.

Imaging Studies

See the list below:

  • Chest radiograph
    • Chest radiographs may reveal a broadened mediastinal mass or bilateral pleural effusions.
    • Preliminary study helps to exclude a perforation and other pathologies included in the differential diagnosis of chest pain.
  • Barium swallow (esophagram)
    • Typically, this study helps to confirm the diagnosis, revealing a filling defect in the mid and lower esophagus, usually on the posterior wall, with luminal narrowing and sometimes with mucosal irregularity.
    • Extravasation into the mediastinum is not observed unless a perforation has occurred.
    • A double barrel sign or a mucosal stripe sign may be demonstrated, that is, double columns of contrast medium separated by a radiolucent stripe and a large intramural mass that reflects a mucosal dissection that allows extravasation of contrast material into the hematoma.
  • CT scan with contrast
    • CT scan reveals a nonenhancing, eccentric, well-defined, intramural esophageal mass that has the density of blood.
    • CT scan can help to better characterize esophagram findings, accurately define the extent of intramural dissection, and exclude esophageal perforation.
    • CT scan is useful in excluding other conditions that may mimic esophageal hematoma, including mass lesions, aortic dissection, and pulmonary embolism.
  • MRI
    • MRI can help demonstrate the extent of the hematoma in various planes and can help rule out additional mediastinal pathology.
    • MRI is indicated for patients who cannot have a CT scan because of an allergy to iodinated contrast medium or renal impairment.
  • An endoscopic ultrasound (EUS) shows an intramural hypoechoic submucosal mass.


See the list below:

  • Upper endoscopy
    • It has been suggested that fiberoptic endoscopy is relatively contraindicated in the further evaluation of esophageal hematoma because many intramural hematomas are contained perforations that could be worsened by the insufflation of air.
    • Others endorse the use of endoscopy in the initial evaluation once esophageal perforation has been ruled out.
    • Endoscopically, an esophageal hematoma is described as a bluish or purplish colored, submucosal mass protruding into the esophageal lumen.
    • Endoscopy can precisely identify the tear in the mucosa, but the risk of the procedure should be weighed against the need for this information and the generally uncomplicated course that these patients follow.
  • Flexible esophagoscopy
    • Flexible esophagoscopy may be a possible diagnostic tool in patients with traumatic esophageal injuries. Arantes et el evaluated the use of this technique in a retrospective (1998-2003) and prospective (2003-2005) study. One hundred sixty-three Findings from flexible esophagoscopy were compared with surgical findings or clinical follow-up in 163 patients with clinical suspicion of esophageal trauma (ie, laceration/perforation, hematoma, abrasion, hematin spots, ecchymosis) assessed.[19] No esophageal lesions were seen in 139 patients (85.3%), but 23 (14.1%) examinations demonstrated esophageal injuries, and 1 (0.6%) case was inconclusive (esophageal stricture).[19] There was surgical confirmation of lacerations in 14 patients. Of 9 patients with observed esophageal contusion, 5 underwent surgical exploration and 4 were managed nonoperatively. The investigators reported flexible esophagoscopy had 95.8% sensitivity, 100% specificity, 99.3% accuracy, 100% positive predictive value, and 99.2% negative predictive value in assessing esophageal injury.[19]
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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