Delayed manifestation of a mid-esophageal tear with profuse hemorrhage after transesophageal echocardiogram.

Esophageal injury or perforation is a rare but life threatening complication of transesophageal echocardiogram (TEE). Most of the patients manifest symptoms within 24 hours of the procedure and upper esophagus is the most common site of injury. We report a patient who underwent TEE for the evaluation of severe valvular insufficiency and 4 days after the procedure developed an esophageal tear in its mid portion associated with profuse upper gastrointestinal bleeding. Though delayed esophageal perforation in the lower segment has been previously reported after a perioperative TEE, no such report exists to our knowledge, in the setting of a nonsurgical TEE.