Disappearing Dysphagia and the Spontaneous Intraesophageal Hematoma
Bibliographic record
Abstract
A 73-year-old woman with atrial fibrillation, on rivaroxaban, presented with a 3-day history of acute dysphagia. Chest computed tomography (CT) showed an esophageal mass (Figure 1). Esophagogastroduodenoscopy revealed severe extrinsic esophageal stenosis (Figure 2). Endoscopic ultrasound-guided biopsy resulted in necroinflammatory debris. At this time, her symptoms of dysphagia began to improve. Repeat chest CT surprisingly showed the mass had disappeared. Instead, a new pre-esophageal lumen was seen (Figure 3). Repeat esophagogastroduodenoscopy discovered a small mucosal defect in the location of the previously biopsied mass (Figure 4). CT esophagram was performed without extravasation of contrast into the false lumen (Figure 5). Chest CT angiography was ordered and revealed a blush of contrast from a midesophageal artery (Figure 6). Interventional radiology performed a selective thoracic angiogram that revealed a small intercostal artery demonstrating an arterial blush, without signs of active bleeding. No further intervention was performed. Intramural esophageal hematoma is an unusual esophageal injury and a rare diagnosis for dysphagia.1 Intramural esophageal hematoma is commonly seen following blunt and penetrating trauma or as a complication of an endoscopic procedure.2 Spontaneous hematomas are those that lack a precipitating event and commonly occur in patients on anticoagulation.3Figure 1.: Chest computed tomography with mediastinal mass causing dysphagia.Figure 2.: Esophagogastroduodenoscopy with severe esophageal stenosis from extrinsic compression.Figure 3.: Repeat chest computed tomography with resolution of the mass and pre-esophageal lumen.Figure 4.: Repeat esophagogastroduodenoscopy with esophageal defect.Figure 5.: Computed tomography esophagram without extravasation of contrast into false lumen.Figure 6.: Chest computed tomography angiography with arterial blush of contrast.DISCLOSURES Author contributions: A. Wayne Wheeler: primary author and contributor and is the article guarantor; S. Landreneau: contributing author, editor, and reviewed case for poster submission and case publication. Financial disclosure: None to report. Previous presentation: Previously presented at the ACG Annual Scientific Meeting; October 20–25, 2023; Vancouver, BC, Canada. Informed consent was obtained for this case report.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".