Esophageal hematoma is a rare condition that can occur spontaneously or in the setting of trauma, toxic ingestions, or as a complication of medical procedures. Esophageal hematomas occur more frequently in women, elderly patients, and patients treated with anticoagulants. Risk factors include underlying coagulopathies, recent esophageal instrumentation (ie, endoscopy, nasogastric or endotracheal tube placement), foreign body ingestion, toxic ingestion, or blunt trauma to the neck or chest.

Patients with spontaneous intramural esophageal hematoma typically present with abrupt, severe retrosternal or epigastric pain with or without radiation that is often aggravated by swallowing. It is often associated with dysphagia or odynophagia. Hematemesis may be present.