A rare cause of esophageal mucosal and submucosal lesions

A 45-year-old male was admitted with palpitations, chest discomfort and a swallowing obstruction of one hour duration after chewing a betel nut. The symptoms appeared within five minutes. His physical examination was unremarkable other than tachycardia and the results of routine laboratory testing were within the normal limits. An electrocardiogram showed sinus tachycardia (ST) and the echocardiography was normal. The patient was given routine oxygen, intravenous fluids and electrolyte replacement therapies. The symptoms of palpitation and chest discomfort were relieved after 30 minutes. However, the swallowing obstruction was not alleviated. The esophagogastroduodenoscopy showed a longitudinal hematoma and multiple superficial ulcers located 20 cm from the incisors down to the gastric cardia. Subsequently, an endoscopic ultrasonography (EUS) was performed, showing that the longitudinal hematoma originated from the submucosa. The swallowing obstruction was resolved after one week and re-examination by esophagogastroduodenoscopy showed healing of the esophageal lesions.