Dieulafoy Lesion
Alexandros D. Polydorides, MD, PhD
Key Facts
Etiology/Pathogenesis
Large caliber artery in mucosa/submucosa, typically protruding through small overlying mucosal defect
Erosion or ulceration of exposed vascular wall, resultant hemorrhage/thrombus
Clinical Issues
Generally rare cause of upper GI bleeding (1-6%)
Mortality: 80% before endoscopy advent, now ˜ 10%
Macroscopic Features
Proximal 10 cm of stomach (lesser curvature)
Microscopic Pathology
Medial hypertrophy, subintimal/adventitial fibrosis
Normal architecture of arterial wall (no aneurysm)
Diagnostic Checklist
Lacks intense inflammation at edge (vs. ulcer)
Muscularis propria not involved, no mural fibrosis
 Hematoxylin & eosin shows a large caliber muscular artery  in esophageal mucosa with a small overlying defect  . Muscularis propria is not involved. (Courtesy H. Appelman, MD.) |
 Elastic von giesson shows preserved internal elastic lamina  with no structural defects (e.g., aneurysm). Note the open vessel wall protruding through the mucosal defect  . (Courtesy H. Appelman, MD.) |
TERMINOLOGY
Synonyms
Caliber-persistent artery or anomaly
“Exulceratio simplex”
Submucosal arterial malformation
Cirsoid, miliary, or atherosclerotic aneurysm
