Introduction: Intramural oesophageal dissection is a rare oesophageal injury that occurs primarily in the elderly and is associated with aggravating factors such as coagulopathy or anticoagulation therapy. It can be emetogenic, trauma-related, iatrogenic or spontaneous. Case Presentation: We present an unusual case of an 87-year-old woman on low dose aspirin who presented with severe chest pain and sudden onset of haematemesis without prior history of forceful vomiting or Valsalva manoeuvres. An emergency upper gastrointestinal endoscopy confirmed the initial diagnosis of a spontaneous intramural oesophageal haematoma and a follow up computed tomography scan of the chest confirmed the presence of an intramural oesophageal dissection. Conclusion: Spontaneous intramural oesophageal dissections should be considered as a differential diagnosis in a patient presenting with acute chest pain without known risk factors such as coagulopathy.

Introduction: Intramural oesophageal dissection is a rare oesophageal injury that occurs primarily in the elderly and is associated with aggravating factors such as coagulopathy or anticoagulation therapy. It can be emetogenic, trauma-related, iatrogenic or spontaneous. Case Presentation: We present an unusual case of an 87-year-old woman on low dose aspirin who presented with severe chest pain and sudden onset of haematemesis without prior history of forceful vomiting or Valsalva manoeuvres. An emergency upper gastrointestinal endoscopy confirmed the initial diagnosis of a spontaneous intramural oesophageal haematoma and a follow up computed tomography scan of the chest confirmed the presence of an intramural oesophageal dissection. Conclusion: Spontaneous intramural oesophageal dissections should be considered as a differential diagnosis in a patient presenting with acute chest pain without known risk factors such as coagulopathy.