Mousab Eteer, MD, (he/him/his)
Intensivist
Henry Ford Hospital
Detroit, MI
Disclosure information not submitted.
Eman Attir, M.D, MPH
Graduate Student
Rush University
Chicago, Illinois, United States
Disclosure information not submitted.
Harini Vijay, D.O
Resident
Henry Ford Hospital
Troy, Michigan, United States
Disclosure information not submitted.
Title: Management of an Intramural Esophageal Hematoma Causing Airway Collapse
Case Report Body:
Introduction:
Intramural Esophageal Hematoma (IEH) is rare complication that often occurs spontaneously, following a traumatic event, or following interventions on or traversing the esophagus. Patients present with nonspecific symptoms such as chest pain, dysphagia, or hematemesis. It often follows a benign course and resolves with conservative management.
Description:
A healthy 53-year-old female presented to an endoscopy center with a week of spasmodic chest pain made worse with food intake. Esophagogastroduodenoscopy revealed mild esophagitis, a hiatal hernia, and ecchymosis involving 3/4th of the esophageal wall. Following the procedure, she developed worsening dyspnea and stridor requiring urgent intubation. Computed Tomography (CT) of the chest showed a collection in the posterior mediastinum displacing the esophagus and trachea anteriorly. Physical examination revealed swelling and tenderness in submental and submandibular spaces. Laboratory evaluation revealed no coagulopathy or liver dysfunction. Repeat CT on hospital day 2 redemonstrated an esophageal/paraoesophageal hematoma with marked posterior pharyngeal edema extending from the subcarinal region to base of the skull. Conservative management with intravenous dexamethasone, mechanical ventilation and serial CT imaging was performed. CT examination on hospital day 8 showed improved subcutaneous edema and a widely patent tracheal lumen with minimal mass effect. Fiberoptic laryngoscopy showed a patent airway and successful extubation over an airway exchange catheter was performed. A video fluoroscopic swallow study showed an adequate ability to swallow. An esophagogram confirmed a patent esophagus without any esophageal perforation. The patient was discharged home on hospital day 12. CT examination five weeks after presentation showed complete resolution of the hematoma.
Discussion:
IEH is a rare condition with a good prognosis. Our experience describes one of the first documented cases causing airway collapse requiring intubation. Conservative management alongside serial physical and imaging examination appear to be sufficient in managing this condition despite its severe presentation. Emphasis on early parenteral nutrition and esophageal rest, a multidisciplinary assessment of the airway and patience aided in this patient’s recovery.