Blue esophagus as a diagnosis of aortic dissection.

A 76-year-old patient, admitted to the department of cardiac surgery, anticoagulated, started with acute dysphagia. An upper endoscopy revealed a blue mucosa from the upper to distal esophagus, with narrowing of the lumen caused by an extrinsic compression. A computed to¬mography (CT) of the thorax was performed, showing a 85x55 mm mediastinal hematoma causing extrinsic compression of the esophagus. Subsequently, a contrast-enhanced CT scan was performed, confirming a contained rupture of descending thoracic aortic dissection as the cause of the hematoma.

Esophageal epidermoid metaplasia. An unusual find.

A 62-year-old woman presented with an episode of upper gastrointestinal bleeding. Upper endoscopy revealed white exudates at the middle and lower third of the esophagus. Biopsies proved epidermoid metaplasia of the esophagus with low-grade dysplasia. We discuss the risk factors, preneoplastic potential and available treatments of this entity.

Gastric plasmacytoma: a rare cause of upper gastrointestinal bleeding.

A 43-year-old female presented to our department with hemoglobin of 3.4 g/dl. She denied gastrointestinal bleeding or weight loss. An upper endoscopy revealed an ulcerative lesion on the greater curvature of the gastric body with two visible clots. Two hemoclips were needed to attain hemostasis, as one of the biopsies of the tumor caused active spurting bleeding. An abdominal computed tomography (CT) demonstrated a well-circumscribed intramural mass arising in the gastric wall, measuring 65 x 50 x 90 mm, with marked internal vascularity and extraluminal component associated. The biopsies identified areas of mature and immature plasmocytes.

Ischemic skin necrosis secondary to the use of terlipressin.

We present the case of a 45-year-old male with alcoholic liver cirrhosis Child-Pugh C and chronic left lower limb lymphedema, hospitalized because of ascites and renal impairment (Cr 2.33 mg/dl). He received intravenous albumin and terlipressin (1 mg every 4h) for suspected hepatorenal syndrome. After 48 hours, purpuric skin lesions appeared on both lower extremities, scrotum and umbilical hernia. Renal function improved (Cr 0.49 mg/dl). Nevertheless, terlipressin was discontinued as the skin lesions worsened due to epidermal detachment, and oral sildenafil was administered at 50 mg twice per day. The left lower limb was severely affected with extensive skin and soft tissue necrosis, which led to supracondylar amputation. All the other lesions had a satisfactory evolution, with reepithelialization of the damaged areas.