Esophageal Hematoma Clinical Presentation

Updated: Dec 03, 2021
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Spontaneous intramural hematoma of the esophagus usually presents initially with severe retrosternal or epigastric pain with or without radiation. The pain is described as abrupt in onset and is aggravated by swallowing.

In one meta-analysis, 35% of patients presented with the triad of chest pain, hematemesis, and dysphagia [7] ; 99% of patients had at least one of these symptoms.


Physical Examination

A complete and thorough physical examination should be performed.

Asking a patient to take a sip of water as part of the general examination may help to unmask symptoms of dysphagia. This may help toward distinguishing between cardiac chest pain and an esophageal disorder causing chest pain.

Palpation looking for the presence of crepitus (suggesting the presence of air under the skin) along the neck, back, and chest can help to rule in or out the presence of an esophageal perforation.