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Spontaneous Paraesophageal Hematoma.

Yan J, Walker C, Chalasani P - ACG Case Rep J (2015)

Bottom Line: Patients with IEH typically present with hematemesis or melena leading to early detection and management, but patients with SPH do not have overt gastrointestinal bleeding on presentation.Management depends on the correction of the underlying causative factor.Awareness of this complication of hemophilia, its clinical manifestations, and imaging findings, allows for a timely diagnosis and appropriate management.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, University of Arizona, Tucson, AZ.

ABSTRACT
Spontaneous paraesophageal hematoma (SPH) likely shares a common etiology with spontaneous intramural esophageal hematoma (IEH). Patients with IEH typically present with hematemesis or melena leading to early detection and management, but patients with SPH do not have overt gastrointestinal bleeding on presentation. Management depends on the correction of the underlying causative factor. We present the first case of a spontaneous paraesophageal hematoma in a patient with hemophilia B. Awareness of this complication of hemophilia, its clinical manifestations, and imaging findings, allows for a timely diagnosis and appropriate management.

No MeSH data available.


Related in: MedlinePlus

Axial contrast-enhanced CT showing (A) a paraesophageal collection and punctate hyperdensity concerning for site of bleeding (arrow), and (B) a paraesophageal hematoma (*) adjacent to a thickened esophagus (arrowheads). Note enhancement along the esophageal adventitia and the adjacent collection, consistent with paraesophageal collection. (C) Coronal contrast-enhanced CT showing collection adjacent to esophagus (*) and a punctate focus of hyperdensity concerning for a site of active bleeding (arrow).
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Figure 1: Axial contrast-enhanced CT showing (A) a paraesophageal collection and punctate hyperdensity concerning for site of bleeding (arrow), and (B) a paraesophageal hematoma (*) adjacent to a thickened esophagus (arrowheads). Note enhancement along the esophageal adventitia and the adjacent collection, consistent with paraesophageal collection. (C) Coronal contrast-enhanced CT showing collection adjacent to esophagus (*) and a punctate focus of hyperdensity concerning for a site of active bleeding (arrow).

Mentions: A 24-year-old man with severe hemophilia B (factor IX level less than 1%) presented with sharp, non-radiating, acute retrosternal chest pain for 1 day that was worsened by oral intake. There were no precipitating or alleviating factors. He reported a history gastrointestinal esophageal reflux but denied emesis, trauma, NSAID or alcohol use, or GI bleeding. Previous hemophilia-related complications included hemarthrosis and intramuscular bleeding. His only medications were 4,000 units of coagulation factor IX as needed. On examination, his vital signs were stable and there were no ecchymosis or signs of trauma to the chest wall. Physical examination was unremarkable except for a right wrist ecchymosis, which was attributed to minor trauma sustained at work. His hemoglobin was 13 gm/dL, and his activated partial thromboplastin time was 126, consistent with history of hemophilia B. Chest computed tomography (CT) showed a paraesophageal hematoma measuring 3 x 1.8 cm surrounding the distal 8.5 cm of the esophagus with mural thickening and inflammatory changes (Figure 1). He was managed conservatively and treated with antacids, clear liquid diet, and 50 units/kg of coagulation factor IX every 12 hours for 5 doses. His factor IX level was maintained at >50%. An esophagogram did not reveal any perforation, and his symptoms resolved after 4 days. He was discharged and remained asymptomatic on outpatient follow-up.


Spontaneous Paraesophageal Hematoma.

Yan J, Walker C, Chalasani P - ACG Case Rep J (2015)

Axial contrast-enhanced CT showing (A) a paraesophageal collection and punctate hyperdensity concerning for site of bleeding (arrow), and (B) a paraesophageal hematoma (*) adjacent to a thickened esophagus (arrowheads). Note enhancement along the esophageal adventitia and the adjacent collection, consistent with paraesophageal collection. (C) Coronal contrast-enhanced CT showing collection adjacent to esophagus (*) and a punctate focus of hyperdensity concerning for a site of active bleeding (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612752&req=5

Figure 1: Axial contrast-enhanced CT showing (A) a paraesophageal collection and punctate hyperdensity concerning for site of bleeding (arrow), and (B) a paraesophageal hematoma (*) adjacent to a thickened esophagus (arrowheads). Note enhancement along the esophageal adventitia and the adjacent collection, consistent with paraesophageal collection. (C) Coronal contrast-enhanced CT showing collection adjacent to esophagus (*) and a punctate focus of hyperdensity concerning for a site of active bleeding (arrow).
Mentions: A 24-year-old man with severe hemophilia B (factor IX level less than 1%) presented with sharp, non-radiating, acute retrosternal chest pain for 1 day that was worsened by oral intake. There were no precipitating or alleviating factors. He reported a history gastrointestinal esophageal reflux but denied emesis, trauma, NSAID or alcohol use, or GI bleeding. Previous hemophilia-related complications included hemarthrosis and intramuscular bleeding. His only medications were 4,000 units of coagulation factor IX as needed. On examination, his vital signs were stable and there were no ecchymosis or signs of trauma to the chest wall. Physical examination was unremarkable except for a right wrist ecchymosis, which was attributed to minor trauma sustained at work. His hemoglobin was 13 gm/dL, and his activated partial thromboplastin time was 126, consistent with history of hemophilia B. Chest computed tomography (CT) showed a paraesophageal hematoma measuring 3 x 1.8 cm surrounding the distal 8.5 cm of the esophagus with mural thickening and inflammatory changes (Figure 1). He was managed conservatively and treated with antacids, clear liquid diet, and 50 units/kg of coagulation factor IX every 12 hours for 5 doses. His factor IX level was maintained at >50%. An esophagogram did not reveal any perforation, and his symptoms resolved after 4 days. He was discharged and remained asymptomatic on outpatient follow-up.

Bottom Line: Patients with IEH typically present with hematemesis or melena leading to early detection and management, but patients with SPH do not have overt gastrointestinal bleeding on presentation.Management depends on the correction of the underlying causative factor.Awareness of this complication of hemophilia, its clinical manifestations, and imaging findings, allows for a timely diagnosis and appropriate management.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, University of Arizona, Tucson, AZ.

ABSTRACT
Spontaneous paraesophageal hematoma (SPH) likely shares a common etiology with spontaneous intramural esophageal hematoma (IEH). Patients with IEH typically present with hematemesis or melena leading to early detection and management, but patients with SPH do not have overt gastrointestinal bleeding on presentation. Management depends on the correction of the underlying causative factor. We present the first case of a spontaneous paraesophageal hematoma in a patient with hemophilia B. Awareness of this complication of hemophilia, its clinical manifestations, and imaging findings, allows for a timely diagnosis and appropriate management.

No MeSH data available.


Related in: MedlinePlus