Extensive Esophageal Intramural Hematoma Induced by Dual Antiplatelet Therapy – Endoscopic Pseudotumor and Dynamic Resolution: A Case Report

Introduction. Esophageal intramural hematoma is an uncommon condition that can mimic malignancy or a submucosal tumor on endoscopy. Dual antiplatelet therapy is a recognized precipitating factor. Case report. We report a 55-year-old male on aspirin and ticagrelor who presented with chest pain, dysphagia, and hematemesis. Contrast-enhanced computed tomography (CT) revealed a longitudinal esophageal mass extending to the cardia without significant enhancement. Initial endoscopy showed an extensive submucosal hematoma and a 3-cm protuberant cardia lesion grossly suspicious for a ruptured gastrointestinal stromal tumor. The patient was managed conservatively with temporary discontinuation of antiplatelet therapy. Repeat endoscopy four days later demonstrated marked hematoma regression and complete resolution of the cardia mass. Histopathology revealed focal squamous epithelial atypia with submucosal hemorrhage, necrosis, and abundant fibrinous inflammatory exudate, requiring distinction from low-grade and high-grade squamous intraepithelial neoplasia, but without evidence of malignancy. Conclusion. This case illustrates radiologic, endoscopic, and pathologic diagnostic pitfalls and highlights the value of short-term endoscopic reassessment to avoid unnecessary surgery.