CTICasesEsophageal Submucosal Hematoma
Imaging findings
CTA of the chest in an 87-year-old female presenting with hematemesis and chest pain shows diffuse, eccentric soft-tissue thickening of the esophageal wall extending from the thoracic inlet to the gastroesophageal junction. A non-contrast CT shows that this thickening is diffusely hyperdense (>60 HU) and represents a spontaneous intramural hematoma, without a mucosal mass. An esophagram confirmed wall dissection without leakage.
Key takeaways
Spontaneous esophageal submucosal hematoma (or intramural esophageal dissection) is an uncommon condition that typically presents in elderly or anticoagulated patients with the triad of chest pain, dysphagia, and hematemesis. It can mimic esophageal malignancy or aortic dissection on CT. Verifying the high attenuation of the wall on non-contrast scans is key to diagnosing hematoma, which is usually managed conservatively.
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