Delayed Manifestation of a Mid‐Esophageal Tear with Profuse Hemorrhage after Transesophageal Echocardiogram

Abstract

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.

The Transesophageal Echo Probe May Contribute to Esophageal Injury After Catheter Ablation for Paroxysmal Atrial Fibrillation Under General Anesthesia: A Preliminary Observation

“…Transesophageal echocardiography (TEE) is widely used in the intra‐operative cardiac surgical and outpatient setting, and is overall a safe procedure associated with a low risk of esophageal injury . However, multiple case reports of TEE‐induced esophageal dissection, tear, perforation, and gastrointestinal bleeding are also appreciated in the literature . TEE is used in an AF ablation setting predominantly to exclude left atrial thrombus, but also to guide transseptal puncture and assess for intra‐procedural complications .…”

Profuse and acute hemorrhagic gastroesophageal injury after cryotherapy in a cardiac surgery patient

“…Mechanisms associated with perioperative TEE are related to direct trauma by manipulation, and indirect processes like prolonged periods of compression with the TEE probe due to lengthy procedures, tissue hypoperfusion, or ischemia due to lack of pulsatile flow and hemodynamic alterations during surgery (10). The other mechanism is thermal injury from the probe tip of TEE (11).…”

“…They said late presentation (>24 hours) was more common than early presentation (<24 hours) and several case reports revealed delayed gastroesophageal manifestations related with placement of TEE probe, 2, 4 and 6 days after surgery (10,11).…”

Transthoracic Echocardiographic Features of Cardiac Pheochromocytoma: A Single‐Institution Experience

“…Early and accurate diagnosis is important for potential surgical removal. [9][10][11] In this investigation, TEE was not performed in all nine patients. 3 TEE in the evaluation of cardiac pheochromocytomas is a well-proven procedure with relatively high sensitivity.…”

“…7,8 However, TEE is a semiinvasive procedure, and occasionally causes complications or discomfort. [9][10][11] In this investigation, TEE was not performed in all nine patients. Before surgical procedure TTE and other imaging techniques were performed to evaluate the cardiac tumors.…”