Two Cases of Spontaneous Submucosal Hematoma of the Esophagus

Submucosal hematoma of the esophagus is a rare disease. We report two cases which developed spontaneously, presenting with chest/back pain.Case 1：A 74-year-old woman was admitted to our hospital with acute onset chest/back pain. She had received antiplatelet agents for treatment of angina pectoris. Chest enhanced CT scan showed a non-enhancing mass occupying the esophageal lumen. Endoscopic examination revealed a large, dark red-colored mass filling the entire esophagus, which was diagnosed as submucosal hematoma of the esophagus. The patient was treated with anti-acid drugs, in conjunction with food deprivation and intravenous hyperalimentation. Endoscopy performed 14 days after admission showed development of deep ulceration along the entire esophageal wall. After three months, the esophageal ulcer had disappeared.Case 2：A 67-year-old woman was referred to our hospital with acute chest/back pain. She had received anticoagulants for treatment of paroxysmal atrial fibrillation. Chest enhanced CT scan and endoscopic examination revealed submucosal hematoma of the esophagus. She was conservatively treated and improved immediately. Examination by endoscopy showed complete improvement of the esophageal lesion two months after onset.It has been reported that conservative management is successful for this disease. Patients receiving antiplatelet agents or anticoagulants are at increased risk of developing submucosal hematoma of the esophagus.