Esophageal Apoplexy

Abstract

A 72-year-old healthy woman presented to the emergency department with acute-onset epigastric pain, diaphoresis, and nausea after eating almonds and bran flakes. Her vital signs showed a blood pressure of 101/63, a pulse rate of 110, and SpO2 95% in room air. On physical examination, the afebrile 72-year-old female patient seemed to be acutely ill, but she was otherwise normal. Laboratory abnormalities were a hemoglobin level of 10.8 and a hematocrit level of 32.2. Computed tomography (CT) of the chest demonstrated a tubular intraluminal mass in the esophagus extending from the thoracic inlet to the gastroesophageal junction (Figure 1). Upper endoscopy showed a pseudolumen with submucosal dissection and intraluminal clot (Figure 2). She was made nothing by mouth (NPO) and managed with intravenous hydration, pain control, and observation. Repeat CT of the chest revealed severe thickening of the esophagus with enhancement of the serosa. Because of inability to take oral feedings, a percutaneous gastrojejunostomy tube was inserted. The patient was discharged and sent to Mayo Clinic's esophageal clinic for consultation. A review of clinical information and CT and endoscopy images led to a diagnosis of esophageal apoplexy. Over the course of a month, the patient had resolution of her chest pain and felt well, with repeat endoscopy demonstrating mild scarring of the esophagus (Figure 2). She was started on oral feedings, and the gastrojejunostomy tube was removed.