PMC10442609_01
(a) Admission plain computed tomography scan showed a continuous hyperabsorptive zone from the thoracic esophagus to the stomach. (b) In the stomach, a clearly demarcated hyperabsorptive zone was observed from the fundus to the upper gastric body, which was considered to be a hematoma. (c) Magnetic resonance imaging on day 2 showed a pale high signal area in the stomach on T1-weighted images. (d) T2-weighted images also showed a low signal area, leading to the diagnosis of acute to subacute submucosal hematoma.
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Due to his allergic reaction to iodine-based contrast, a plain computed tomography (CT) scan was performed to identify the source of the bleeding, which revealed a suspected blood-filled gastric reservoir and a suspected submucosal hematoma extending from the thoracic esophagus to the stomach (Figure 1a,b). Furthermore, magnetic resonance imaging (MRI) showed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images in the same area, leading to the diagnosis of acute to subacute gastroesophageal submucosal hematoma (Figure 1c,d).
(a) On day 2, esophagogastroduodenoscopy revealed a reddish-purple submucosal tumor-like enhancement in the thoracic esophagus (30 cm from the oral cavity), which was thought to be a hematoma. (b) The hematoma was continuous toward the stomach, and the esophageal wall was partially narrowed. (c) However, passage of the scope was possible and the hematoma extended beyond the esophagogastric junction into the stomach. (d) The hematoma was observed from the fundus to the upper body of the stomach.
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On day 2, esophagogastroduodenoscopy (EGD) revealed a reddish-purple submucosal tumor-like enhancement extending vertically from the thoracic esophagus to the isthmus (Figure 2).
(a) On day 9, esophagogastroduodenoscopy showed that the esophageal hematoma had resolved and an ulcer had formed. (b) The hematoma at the site of the narrowing had also disappeared and no stricture was observed. (c) The ulcer extended from the esophagus to the stomach. (d) The intragastric hematoma had also disappeared and an ulcer had formed.
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A follow-up EGD performed on day 9 showed the disappearance of the hematoma and the appearance of an ulcer at the site of the previous hematoma (Figure 3).
(a-c) Three months later, esophagogastroduodenoscopy revealed that the base of the esophageal ulcer was covered by normal mucosa and scarred. (d) The ulcer in the area from the fundus to the upper body of the stomach was also scarred and had a good healing course.
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A 3-month follow-up EGD showed scarring of the ulcer base, confirming the healing process (Figure 4).