The pulsatile bulge on the oesophagus: rare cause for hematemesis

Abstract

His white cell count was 22,000/mm3 with 90% of neutrophils, haemoglobin was 10g/dL and platelet was 364 X 109 /L. His C-Reactive Protein (CRP) was 221 mg/L on admission. Other blood investigations were unremarkable. The ini t ia l b lood cul ture was negat ive and the echocardiogram did not reveal any vegetation. As he had a history of dysphagia, he underwent upper gastrointestinal endoscopy (UGIE) which revealed a narrowing of the oesophagus at the level of 28 cm from incisor teeth but there were no mucosal abnormalities. Subsequently, he underwent Computed Tomography (CT) chest and abdomen. CT revealed a saccular descending thoracic aneurysm extending up to the level of the celiac artery with evidence of concealed rupture (Figure 1) and gas pockets around the aneurysm (Figure 2). While he was awaiting an urgent repair, he developed massive hematemesis and died.