Ruptured oesophageal haematoma caused by transoesophageal echocardiography

A 78-year-old man with a history of aortic valve replacement underwent percutaneous closure of a significant paravalvular leak, under transoesophageal echocardiography guidance. On the third day post-procedure, the patient complained of dysphagia, haemoptysis, and chest pain aggravated by swallowing. Gastroscopy, as well as a contrast radiography, showed complete oesophageal obstruction at 25 cm from the teeth. (Panels A and B) Subsequent computed tomography (CT) revealed a large haematoma of the oesophageal wall obstructing the lumen of the oesophagus, compressing the left atrium and left pulmonary veins. (Panel C, red arrow) Because of a stable clinical status and active anticoagulation, surgical intervention was withheld. However, on the next day, the patient’s condition worsened gradually. On physical examination, a notable apex beat aggravation and displacement was observed…