Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

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.
Next

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.
Previous
Next

Procedures

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]
Previous
 
 
Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

References
  1. Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol. 1988 Nov. 39(6):628-34. [Medline].

  2. Adeonigbagbe O, Khademi A, Washington M. Spontaneous esophageal hematoma. Am J Gastroenterol. 1999 Dec. 94(12):3655. [Medline].

  3. Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos. 1999 Dec. 50(6):850-1. [Medline].

  4. Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol. 1999 Aug. 94(8):2282-4. [Medline].

  5. Meulman N, Evans J, Watson A. Spontaneous intramural haematoma of the oesophagus: a report of three cases and review of the literature. Aust N Z J Surg. 1994 Mar. 64(3):190-3. [Medline].

  6. Lu MS, Liu YH, Liu HP, et al. Spontaneous intramural esophageal hematoma. Ann Thorac Surg. 2004 Jul. 78(1):343-5. [Medline].

  7. Cheung J, Muller N, Weiss A. Spontaneous intramural esophageal hematoma: case report and review. Can J Gastroenterol. 2006 Apr. 20(4):285-6. [Medline]. [Full Text].

  8. Chen HL, Chang WH, Shih SC, et al. A rare cause of melena: spontaneous esophageal hematoma. Gastrointest Endosc. 2008 Mar. 67(3):539. [Medline].

  9. Chiu YH, Chen JD, Hsu CY, et al. Spontaneous esophageal injury: esophageal intramural hematoma. J Chin Med Assoc. 2009 Sep. 72(9):498-500. [Medline].

  10. Baehr PH, McDonald GB. Esophageal disorders caused by infection, systemic illness, medications, radiation, and trauma. Feldman M, Scharschmidt BF, Sleisenger MH, eds. Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Philadelphia, Pa: WB Saunders Co; 1998. 534.

  11. Cullen SN, Chapman RW. Dissecting intramural haematoma of the oesophagus exacerbated by heparin therapy. QJM. 1999 Feb. 92(2):123-4. [Medline].

  12. Wang AY, Riordan RD, Yang N, Hiew CY. Intramural haematoma of the oesophagus presenting as an unusual complication of endotracheal intubation. Australas Radiol. 2007 Dec. 51 Suppl:B260-4. [Medline].

  13. Marks IN, Keet AD. Intramural rupture of the oesophagus. Br Med J. 1968 Aug 31. 3(617):536-7. [Medline].

  14. Yamashita S, Takeno S, Moroga T, Kamei M, Ono K, Takahashi Y, et al. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave's syndrome). Hepatogastroenterology. 2012 May. 59(115):745-6. [Medline].

  15. Yin A, Li Y, Jiang Y, Liu J, Luo H. Mallory-Weiss syndrome: clinical and endoscopic characteristics. Eur J Intern Med. 2012 Jun. 23(4):e92-6. [Medline].

  16. Fujisawa N, Inamori M, Sekino Y, Akimoto K, Iida H, Takahata A, et al. Risk factors for mortality in patients with Mallory-Weiss syndrome. Hepatogastroenterology. 2011 Mar-Apr. 58(106):417-20. [Medline].

  17. Kumar V, Mallikarjuna HM, Gokulnath. A miniseries of spontaneous intramural esophageal hematoma in hemodialysis patients: a rare cause of dysphagia. Hemodial Int. 2014 Apr. 18(2):558-61. [Medline].

  18. Kumar S, Ling LH, Halloran K, et al. Esophageal hematoma after atrial fibrillation ablation: incidence, clinical features, and sequelae of esophageal injury of a different sort. Circ Arrhythm Electrophysiol. 2012 Aug 1. 5(4):701-5. [Medline].

  19. Arantes V, Campolina C, Valerio SH, et al. Flexible esophagoscopy as a diagnostic tool for traumatic esophageal injuries. J Trauma. 2009 Jun. 66(6):1677-82. [Medline].

  20. Carrott PW Jr, Low DE. Advances in the management of esophageal perforation. Thorac Surg Clin. 2011 Nov. 21(4):541-55. [Medline].

  21. Alani FS. Extensive oesophageal haematoma with haematemesis treated by sclerosant injections. Endoscopy. 1995 Feb. 27(2):213-4. [Medline].

  22. Amott DH, Wright GM. Dissecting haematoma of the oesophagus masquerading as acute myocardial infarction. Med J Aust. 2006 Feb 20. 184(4):182-3. [Medline].

  23. Blaivas M, Hom DB, Younger JG. Thyroid gland hematoma after blunt cervical trauma. Am J Emerg Med. 1999 Jul. 17(4):348-50. [Medline].

  24. Bonnette P, Lansac E, Fritsch J. [Intramural hematoma of the esophagus: a rare diagnosis]. Rev Mal Respir. 1999 Dec. 16(6):1147-50. [Medline].

  25. Cullen SN, McIntyre AS. Dissecting intramural haematoma of the oesophagus. Eur J Gastroenterol Hepatol. 2000 Oct. 12(10):1151-62. [Medline].

  26. Faigel DO. Miscellaneous disease of the esophagus: systemic, dermatologic disease, foreign bodies and physical injury. Yamada T, Alpers DH, Kaplowitz N, et al., eds. Textbook of Gastroenterology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003. 1269.

  27. Folan RD, Smith RE, Head JM. Esophageal hematoma and tear requiring emergency surgical intervention. A case report and literature review. Dig Dis Sci. 1992 Dec. 37(12):1918-21. [Medline].

  28. Geller A, Gostout CJ. Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment. Mayo Clin Proc. 1998 Apr. 73(4):342-5.

  29. Maher MM, Murphy J, Dervan P. Aorto-oesophageal fistula presenting as a submucosal oesophageal haematoma. Br J Radiol. 1998 Sep. 71(849):972-4. [Medline].

  30. McIntyre AS, Ayres R, Atherton J. Dissecting intramural haematoma of the oesophagus. QJM. 1998 Oct. 91(10):701-5. [Medline].

  31. Shim J, Jang JY, Hwangbo Y, et al. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: treatment with therapeutic angiography. World J Gastroenterol. 2009 Nov 7. 15(41):5232-5. [Medline]. [Full Text].

  32. Skillington PD, Matar KS, Gardner MA. Intramural haematoma of the oesophagus complicated by perforation. Aust N Z J Surg. 1989 May. 59(5):430-2. [Medline].

  33. Thomasset SC, Berry DP. Spontaneous intramural esophageal hematoma. J Gastrointest Surg. 2005 Jan. 9(1):155-6. [Medline].

  34. Tong M, Hung WK, Law S, et al. Esophageal hematoma. Dis Esophagus. 2006. 19(3):200-2. [Medline].

  35. Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol. 1999 Dec. 29(4):306-17. [Medline].

  36. Yuen EH, Yang WT, Lam WW. Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances. Australas Radiol. 1998 May. 42(2):139-42. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.