Possible Association Between Esophageal Hematoma and Prior Chest Radiation: A Case Report

We report a novel case of esophageal hematoma potentially linked to prior chest radiation therapy, highlighting an underexplored area in patient care post-radiotherapy.

A 73-year-old female presented with acute chest pain, dysphagia, and odynophagia.

Her medical history was significant for Hodgkin’s lymphoma treated over two decades ago with chemotherapy and extensive chest radiation, leading to subsequent aortic valve degeneration and replacement [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12].

Initial CT angiography excluded aortic dissection but revealed esophageal wall thickening. Esophagogastroduodenoscopy confirmed a prolonged esophageal hematoma with a small active bleed, successfully treated with hemostasis therapy.

The patient, on chronic low-dose aspirin, had no typical risk factors beyond radiation exposure, suggesting a link between prior radiation and esophageal hematoma formation.

Theoretical mechanisms include radiation-induced endothelial damage leading to a pro-thrombotic state and chronic inflammation, predisposing to hematoma development.

The patient's recovery involved a temporary cessation of oral intake followed by gradual resumption, and follow-up endoscopy showed hematoma resolution but significant esophagitis, managed with proton pump inhibitors.

This case emphasizes the necessity for clinicians to consider the long-term esophageal effects of chest radiation in cancer survivors, particularly when encountering atypical esophageal presentations.

Publication History

Article published online:
27 March 2025

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