Radiology case reports
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Radiology case reports · Aug 2020
Case ReportsUndiagnosed aortoesophageal fistula causing intramural hematoma of the esophagus.
Aortoesophageal 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. ⋯ 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.