Spontaneous Intramural Oesophageal Haematoma (IEH) is a rare oesophageal emergency. This report describes the case of a 70-year-old diabetic male, who presented with chest pain and was started on thrombolysis as Electrocardiography (ECG) showed ST elevation Myocardial Infarction (MI). As the patient developed gum bleeding and neck swelling, thrombolysis was stopped. Computed Tomography (CT) showed a non-enhancing mediastinal mass, causing significant extrinsic compression of the distal trachea

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... nd a diagnosis of IEH, possibly secondary to thrombolysis was made. Although IEH generally resolves spontaneously with conservative management, the patient remained poorly ventilated despite intubation and expired due to cardiac arrest following failure of resuscitative efforts, eight days after the initial thrombolysis. Several cases of uncomplicated IEH where complete recovery was achieved with conservative treatment are reported in literature; however, there are fewer reports on the poorer outcomes in patients with multiple co-morbidities and co-existent clinical complications.