IS Case 282: Esophageal varices

Neal Young, MD

Imaging Sciences URMC 2009
Publication Date: 2009-08-05

History

Patient is a 55 year-old male with liver disease of unknown etiology. Liver biopsy demonstrated mild fibrosis and no cirrhosis.

Findings

Frontal radiograph (Fig. 1) shows a posterior mediastinal mass extending to the right of the spine. Figure 2 shows an ill-defined posterior mediastinal mass better delineated with IV contrast on Figure 3. Finally, the superior extent of the varices can be appreciated on Figure 4.

Diagnosis

Esophageal varices

Discussion

Esophageal varices are collateral vessels within the wall of the esophagus and are due to portal hypertension. Blood flow is diverted through the left gastric vein to the esophageal venous plexus. Liver Cirrhosis is the most common cause. Hemorrhage is a complication that can occur in up to 30% of patients and there is a high mortality rate. Splenomegaly often occurs due to portal hypertension as well.

References

  1. Cihangiroglu M, Lin BH, Dachman AH. Collateral pathways in superior vena caval obstruction as seen on CT. J Comput Assist Tomogr. 2001 Jan-Feb;25(1):1-8. PMID: 11176285 [PubMed]

4 images