Kimmoun Antoine, Abboud Georges, Steinbach Gérard, Tellaroli Jean-Claude, Bemer Michel
Service de réanimation polyvalente, CHR de Metz-Thionville, Hôpital Bel Air, F-57126 Thionville, France.
Presse Med. 2008 Mar;37(3 Pt 1):420-3. doi: 10.1016/j.lpm.2007.04.043. Epub 2007 Dec 21.
Dissecting intramural hematoma of the esophagus is a rare cause of chest pain that can be misinterpreted as a myocardial infarction. The use of anticoagulants in this case may lead to hemorrhagic complications.
A 51-year-old patient, with coronary artery disease, diabetes, hypertension and dependent on both alcohol and tobacco, was admitted for chest pain and an elevated troponin T plasma level. He was treated with anticoagulants. He developed hematemesis on the third day and was transferred to intensive care. Esophageal endoscopy revealed a hematoma with active bleeding, covered by esophageal mucosa from the middle to the lower third of the esophagus (for 13 cm). Computed tomography allowed us to rule out an aortoesophageal fistula. Symptomatic treatment consisted of withdrawing the anticoagulant, mechanical ventilation, intravenous sedation, and blood transfusion. The patient recovered, after a long stay in ICU.
Intramural dissecting hematoma of the esophagus is not always easy to diagnose. Administration of anticoagulant treatment after a misdiagnosis of acute coronary syndrome can have serious hemorrhagic consequences. Prognosis is excellent with conservative treatment.
