Esophagogastric intramural hematoma mimicking varices and a gastric fundal mass

Esophagogastric intramural hematoma is rare and may mimic varices or an upper gastrointestinal neoplasm. We report a hemodynamically stable patient receiving long-term aspirin therapy who developed melena after gastroscopy and colonoscopy at a referring hospital. Contrast-enhanced computed tomography showed a continuous hyperattenuating mural lesion extending approximately 16 cm from the distal esophagus across the esophagogastric junction into the cardia and gastric fundus, with a 3.8 × 2.6 cm mass-like fundal component and no active contrast extravasation, perforation or radiological evidence of portal hypertension. Endoscopy revealed bluish, varix-like submucosal bulging. Conservative treatment and temporary aspirin withdrawal resulted in substantial hematoma regression within six days, with subsequent ulcer formation in the distal esophagus and cardia. Biopsy of the cardial ulcer showed no evidence of malignancy. No recurrent bleeding or related symptoms occurred during one-month follow-up.