• Timothy Stooksberry, Bruce McHam, and Mark Lisle.
• Department of Radiology, West Virginia University School of Medicine, Suite 2244 Health Sciences South/PO Box 9235, Morgantown, WV 26506-9235, USA.
• Radiol Case Rep. 2020 Aug 1; 15 (8): 1128-1132.

AbstractAortoesophageal fistula (AEF) is a rare, but life-threatening cause of intramural hematoma of the esophagus (IHE). Typical clinical presentation of AEF includes midthoracic pain and sentinel hemorrhage followed by massive, often fatal, hematemesis, with the period between sentinel hemorrhage and massive hematemesis generally varying from hours to days. This is a case of a 61-year-old male who presented with chest pain after development of an aortoesophageal fistula and associated intramural hematoma of the esophagus. The fistula and associated hematoma were initially mischaracterized on imaging, and went undiagnosed for approximately 2 weeks before being iatrogenically disrupted during endoscopy. Though this case was successfully treated, aortoesophageal fistulas are associated with a high mortality, and aortoesophageal fistula/intramural hematoma of the esophagus should always be considered in the differential of an esophageal mass.© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

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