Oesophageal dissection after thrombolytic treatment for myocardial infarction

Dissecting intramural hematoma of esophagus after thrombolytic therapy: a case report

Esophageal hematoma is a relatively rare event. We report a case of severe chest pain associated with myocardial infarction and recurrent chest pain after administration of a thrombolytic agent. The chest pain was different from the presenting symptom and accompanied by 2 episodes of hematemesis. Esophageal hematoma was confirmed after endoscopy and computed tomography. Esophageal hematoma is a relatively rare event after thrombolytic therapy.

Intramural hematoma of the esophagus: a pictorial essay

Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients may be treated conservatively with good outcome.

Oesophageal dissection: contrast studies and CT in diagnosis and monitoring

Oesophageal dissection with intramural haematoma formation can be difficult to diagnose. Endoscopy can be diagnostic, but imaging techniques including computed tomography and contrast swallows can both accurately demonstrate a dissection and exclude many other pathologies. A case utilizing both imaging modalities to diagnose and monitor the condition in a patient with a bleeding disorder is presented.

Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment

Esophagogastric hematoma is a rare condition occurring spontaneously or after esophageal instrumentation. In this report, we describe a patient with acute dysphagia in whom a lower esophageal mass was detected radiographically. Upper endoscopy revealed an esophageal mass that extended from the mid-esophagus to the gastroesophageal junction and was associated with a malignant-appearing ulcerated mass (5 to 6 cm) in the cardia. Gastric cancer with esophageal extension was the presumptive diagnosis. Computed tomography showed that the esophageal mass had a density similar to blood, a finding suggesting the presence of an esophageal hematoma. Biopsy specimens of the ulcer revealed acute inflammation but no malignant involvement. The patient was treated conservatively, and the initial symptoms resolved. Esophagogastric hematomas can mimic a neoplasm; thus, establishing the correct diagnosis is important because this condition has a favorable prognosis, and only conservative treatment is needed.

Intramural hematoma of the esophagus: appearance on magnetic resonance imaging

A 73-yr-old woman on anticoagulant therapy experienced progressive dyspnea and dysphagia due to a large compressing mass in the posterior mediastinum. Because her clinical condition deteriorated rapidly surgery was performed. A large intramural hematoma along the full length of the esophagus with dissection of the muscular layers of the esophagus was found. MRI findings of this case are reported.

Smoking control and cessation

Over the last 30 years the prevalence of cigarette smoking in adults in the UK has fallen to around 30%. Smoking will still kill 100,000 people each year well into the next century. Smoking in children is related to whether their parents smoke. Moves to reduce smoking in adults will therefore reduce smoking in children. The Government should be urged to raise taxes on cigarettes and ban advertising. Smoking should be banned from all health care premises. Hospitals should be encouraged to appoint smoking cessation counsellors to work with both staff and patients.