Alirezaei Toktam, Irilouzadian Rana, Pirsalehi Ali, Nekooghadam Sayyed Mojtaba
Cardiology Department of Shohadaye-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Case Rep Med. 2022 Jun 15;2022:5636989. doi: 10.1155/2022/5636989. eCollection 2022.
A 59-year-old female with a history of mitral valve replacement presented to emergency department, complaining of sudden-onset retrosternal chest pain since 4 hours ago. Electrocardiogram, laboratory tests, and computed tomography (CT) angiography of aorta were performed and ruled out aortic dissection and cardiovascular events. However, new complaint of odynophagia, dysphagia, and incidental findings in CT angiography proposed esophageal pathologies. After initial workup including upper gastrointestinal endoscopy, intramural esophageal hematoma was diagnosed. Laboratory tests revealed significant reduction in the hemoglobin level. Management of warfarin-induced major bleeding in a patient whom anticoagulation was necessary for the prevention of mechanical heart valve thrombosis was challenging. The patient recovered fully with conservative treatment and was discharged on hospital day 14 with low molecular weight heparin. We described a case of intramural esophageal hematoma as a rare condition that could be misdiagnosed as a cardiovascular emergent disease and would be worsened by antiplatelet and anticoagulation therapy. Accordingly, it is important to differentiate intramural esophageal hematoma from cardiac ischemic events. Another challenge was correction of coagulation in the presence of mechanical mitral valve. Fortunately, we had a favorable outcome following conservative management.
一名有二尖瓣置换病史的59岁女性因4小时前突发胸骨后胸痛就诊于急诊科。进行了心电图、实验室检查及主动脉计算机断层扫描（CT）血管造影，排除了主动脉夹层和心血管事件。然而，新出现的吞咽疼痛、吞咽困难主诉以及CT血管造影中的偶然发现提示存在食管病变。经过包括上消化道内镜检查在内的初步检查，诊断为壁内食管血肿。实验室检查显示血红蛋白水平显著降低。对于一名为预防机械性心脏瓣膜血栓形成而必须进行抗凝治疗的患者，处理华法林引起的严重出血具有挑战性。患者经保守治疗完全康复，于住院第14天出院，出院时使用低分子量肝素。我们描述了一例壁内食管血肿病例，这是一种罕见疾病，可能被误诊为心血管急症，且抗血小板和抗凝治疗会使其病情恶化。因此，将壁内食管血肿与心脏缺血事件相鉴别很重要。另一个挑战是在存在机械二尖瓣的情况下纠正凝血功能。幸运的是，经过保守治疗我们取得了良好的结果。
