Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: Treatment with therapeutic angiography

Figure 1 Endoscopic view. A: A small opening in the cervical esophagus; B: Mucosal bridging with a large mucosal defect in the esophagogastric junction.

Figure 2 Chest CT images. A: The transverse view of the proximal esophagus shows a concentric intramural hematoma and mucosal dissection with an air-fluid level in the false lumen (arrow). Bilateral pleural effusions are seen; B: The sagittal view shows an extensive intramural hematoma of the esophagus.

Figure 3 Celiac angiography showing a hyperstaining pseudoaneurysmal lesion (arrow) in an esophageal branch of the left gastric artery. The branch was embolized using glue and lipiodol.

Figure 4 Follow-up chest CT. A: The transverse view of the proximal esophagus showing a resolved intramural hematoma and improved dissection (arrow); B: The embolized lesion is seen as focal lipiodol uptake in the distal esophagus (arrow).