Downhill esophageal varices

Case contributed by Dr Jayanth Keshavamurthy

Presentation

This patient underwent upper endoscopy for dysphagia which showed upper oesophageal varices and hence a CT scan of the chest was ordered.

Patient Data

Age: 65 years
Gender: Male
Photo

Isolated upper esophageal varix.  None in the lower esophagus.

CT scan of the chest was ordered.

CT

SVC stenosis is noted. Collaterals noted via collateral branches to the intercostal and inferior phrenic vein. These are systemic to systemic collaterals and not systemic to portal collaterals.

Annotated image

SVC stenosis (blue arrow) is noted. Collaterals noted (red arrows) via collateral branches to the intercostal and inferior phrenic vein.

DSA (angiography)

1. See the collaterals via thyroidal branches like the CT.

2. SVC stenosis close to RA junction.

3. Post ballooning there is no significant stenosis.

Annotated image

SVC stenosis close to RA junction (blue arrow). 

Case Discussion

The patient previously had a right-sided Port-A-Cath. The catheter had been removed for a clot or stenosis seen on CT neck a few months prior in a different hospital. This history is important as a radiologist sees the collaterals very often and would not call it a varix unless that history is provided in detail.

Downhill esophageal varix secondary to SVC stenosis after long-standing catheter placement like a Port-A-Cath or dialysis catheter is underreported by radiologists,

PlayAdd to Share

Case information

rID: 71489
Published: 8th Oct 2019
Last edited: 10th Oct 2019
Inclusion in quiz mode: Included
Institution: Augusta University

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.