Esophageal hematoma as a complication of transesophageal echocardiography in a pulmonary vein ablation procedure.

Authors

  • Mauricio Sebastián Urgilés Ortiz Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0009-0007-3202-441X
  • Juan Ignacio Lubian Esplugues Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0009-0002-0361-1344
  • Cesar Jiménez Méndez Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0000-0003-0282-3302
  • Ana Pérez Asensio Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain
  • Manuel Jesús Tey Aguilera Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0000-0003-0667-7672
  • Tarek Alejandro Grez Gutierrez Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0009-0004-5505-5196
  • Luis Martin Alfaro Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain https://orcid.org/0009-0002-8037-4565
  • Rafael Vásquez García Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain

DOI:

https://doi.org/10.37615/retic.v8n2a6

Keywords:

esophageal hematoma, pulmonary vein ablation, transesophageal echocardiography, atrial fibrillation

Abstract

Transesophageal echocardiography is used during pulmonary vein ablation to rule out thrombi in the left atrial appendage and to guide transseptal puncture. It is a safe procedure, but among its complications is esophageal hematoma with a frequency < 1 %. It presents with dysphagia, odynophagia or hematemesis. It has been associated with administration of high doses of heparin. Unlike atrioesophageal fistula, it appears early and is not accompanied by infectious symptoms. Diagnosis is made by chest CT scan. Treatment is conservative, with analgesia, fasting and withdrawal of anticoagulation. It usually evolves favorably and resolves spontaneously. Endoscopic follow-up is recommended to rule out esophageal complications in the medium to long term.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biography

Cesar Jiménez Méndez, Cardiology Department. Puerta del Mar University Hospital. Cádiz. Spain

Area Specialist Physician. Cardiology Department. Puerta del Mar University Hospital. Cádiz

References

Benjamin EJ, Muntner P, Alonso A, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019 Mar 5;139(10):e56-e528. doi: 10.1161/CIR.0000000000000659. Erratum in: Circulation. 2020 Jan 14;141(2):e33. doi: 10.1161/CIR.0000000000000746. PMID: 30700139. DOI: https://doi.org/10.1161/CIR.0000000000000746

Nyong J, Amit G, Adler AJ, Owolabi OO, Perel P, Prieto-Merino D, Lambiase P, Casas JP, Morillo CA. Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. Cochrane Database Syst Rev. 2016 Nov 22;11(11):CD012088. https://doi.org/10.1002/14651858.CD012088.pub2 DOI: https://doi.org/10.1002/14651858.CD012088.pub2

Sharma A, Hoilat GJ, Ahmad SA. Esophageal Hematoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

Wong YM, Makmur A, Lau LC, Ting E. Temporal Evolution of Intramural Esophageal Dissection with 3D Reconstruction and Cinematic Virtual Fly-Through. J Radiol Case Rep. 2018 Feb 28;12(2):11-17. https://doi.org/10.3941/jrcr.v12i2.3288 DOI: https://doi.org/10.3941/jrcr.v12i2.3288

Bertaglia E, Zoppo F, Tondo C, Colella A, Mantovan R, Senatore G, Bottoni N, Carreras G, Corò L, Turco P, Mantica M, Stabile G. Early complications of pulmonary vein catheter ablation for atrial fibrillation: a multicenter prospective registry on procedural safety. Heart Rhythm. 2007 Oct;4(10):1265-71. https://doi.org/10.1016/j.hrthm.2007.06.016 DOI: https://doi.org/10.1016/j.hrthm.2007.06.016

Randhawa MS, Rai MP, Dhar G, Bandi A. Large oesophageal haematoma as a result of transoesophageal echocardiogram (TEE). BMJ Case Rep. 2017 Nov 8; bcr2017223278. https://doi.org/10.1136/bcr-2017-223278 DOI: https://doi.org/10.1136/bcr-2017-223278

Kawasaki R, Gauri A, Elmouchi D, Duggal M, Bhan A. Atrioesophageal fistula complicating cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2014 Jul;25(7):787-92. https://doi.org/10.1111/jce.12426 DOI: https://doi.org/10.1111/jce.12426

Bhat T, Baydoun H, Asti D, Rijal J, Teli S, Tantray M, Bhat H, Kowalski M. Major complications of cryoballoon catheter ablation for atrial fibrillation and their management. Expert Rev Cardiovasc Ther. 2014 Sep;12(9):1111-8. https://doi.org/10.1586/14779072.2014.925802 DOI: https://doi.org/10.1586/14779072.2014.925802

Akao K, Ishida Y, Nakazawa K, Okada T, Fujiyoshi T, Kawachi A, Uchino H. Esophageal Submucosal Giant Hematoma Detected After Mitral Repair Using Transesophageal Echocardiography. Cureus. 2022 Jul 26;14(7):e27292. https://doi.org/10.7759/cureus.27292 DOI: https://doi.org/10.7759/cureus.27292

Downloads

Published

2025-08-26

How to Cite

1.
Urgilés Ortiz MS, Lubian Esplugues JI, Jiménez Méndez C, Pérez Asensio A, Tey Aguilera MJ, Grez Gutierrez TA, Martin Alfaro L, Vásquez García R. Esophageal hematoma as a complication of transesophageal echocardiography in a pulmonary vein ablation procedure. Rev Ecocardiogr Pract Otras Tec Imag Card (RETIC) [Internet]. 2025 Aug. 26 [cited 2025 Sep. 4];8(2):22-5. Available from: https://imagenretic.org/RevEcocarPract/article/view/703

Issue

Vol. 8 No. 2 (2025): Revista de Ecocardiografía Práctica y Otras Técnicas de Imagen Cardíaca

Section

CLINICAL CASES

License

Copyright (c) 2025 Mauricio Sebastián Urgilés Ortiz , Juan Ignacio Lubian Esplugues, Cesar Jiménez Méndez, Ana Pérez Asensio, Manuel Jesús Tey Aguilera, Tarek Alejandro Grez Gutierrez, Luis Martin Alfaro, Rafael Vásquez García

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

RETIC is distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license https://creativecommons.org/licenses/by-nc-nd/4.0 which allows sharing, copying and redistribution of the material in any medium or format, under the following terms:

  • Attribution: you must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests that the licensor endorses you or your use.
  • Non-commercial: you may not use the material for commercial purposes.
  • No Derivatives: if you remix, transform or build upon the material, you may not distribute the modified material.
  • No Additional Restrictions: you may not apply legal terms or technological measures that legally restrict others from doing anything permitted by the license.
Crossref
Scopus
Google Scholar
Europe PMC