Intramural esophageal hematoma is a very rare condition. We report a case of a 40-year-old male, presenting with retrosternal pain and dysphagia. On the day before admission tarry stool and minimal vomiting of old blood was noticed. Diagnostic procedures showed an intramural esophageal hematoma, which had developed 2 weeks and 3 days after cardioversion and anticoagulation therapy. Etiology, differential diagnosis, the diagnostic approach and a brief review of the literature are discussed.