Oesophageal Hematoma After Curry Meal

摘要

Intramural oesophageal hematoma is a rare endoscopic diagnosis. It can be easily misdiagnosed as aortic dissection or a cardiac event. It may or may not be associated with oesophageal perforation. In majority of cases it can be managed conservatively. A high index of suspicion is required to request endoscopy. Here we present a case of oesophageal hematoma in a lady who was not on anti-platelet or anticoagulants. She presented with dysphagia and central chest pain. Case History A 54-year-old woman presented to the accident and emergency department after eating chicken curry. While eating she suddenly developed dysphagia and severe central chest pain radiating to the back. It was accompanied by shortness of breath and few bouts of hematemesis. She had a background of mild dyspepsia for which she was taking omeprazole. There was no other significant past medical history or drug use. She was a non-smoker and had no risk factors for ischemic heart disease.She was hemodynamically stable without any difference in blood pressure in both arms. There was no subcutaneous emphysema and the abdomen was soft with only mild epigastric tenderness. Cardiovascular and respiratory examinations were unremarkable. Laboratory investigations including full blood count, clotting screen, renal/liver function, and serum amylase) were within normal ranges. The repeat haemoglobin after few hours remained normal as well. An electrocardiogram, chest and abdominal radiographs were also normal.Gastroscopy revealed a large intramural oesophageal hematoma extending from 22 to 36 centimetres from incisors (Fig 1 and 2).