Esophageal Varices



Esophageal Varices


Michael P. Federle, MD, FACR









(Left) Graphic shows dilated, tortuous, submucosal collateral veins (varices) within the wall of the esophagus. (Right) Double-contrast esophagram shows tortuous, nodular longitudinal “folds,” typical of varices. These are unusually well depicted, even with the esophageal lumen distended, suggesting that the varices may be thrombosed or sclerosed by endoscopic injection.






(Left) Axial CECT in a 55-year-old man with upper GI bleeding shows large esophageal varices image. (Right) Esophagram in the same patient, performed after endoscopic sclerosis of the varices, shows fixed filling defects image in the esophageal wall and lumen. The fixed nature of these mimics the appearance of the “varicoid” morphology of some esophageal carcinomas.



TERMINOLOGY


Definitions



  • Dilated tortuous submucosal venous plexus of esophagus


IMAGING


General Features



  • Best diagnostic clue



    • Tortuous or serpiginous longitudinal filling defects on esophagography


  • Location



    • Uphill varices: Distal 1/3 or 1/2 of esophagus (more common)


    • Downhill varices: Upper or middle 1/3 of esophagus (less common)


  • Morphology



    • Tortuous dilated veins in long axis of esophagus, protruding directly beneath mucosa or in periesophageal tissue


  • Other general features



    • Usually due to portal HTN with cirrhosis or other liver diseases


    • Idiopathic varices: In patients with no portal HTN or SVC block (very rare)


    • Classification of esophageal varices based on pathophysiology



      • Uphill varices: ↑ portal venous pressure → upward venous flow via dilated esophageal collaterals to superior vena cava (SVC)


      • Downhill varices: Obstruction of SVC → downward venous flow via esophageal collaterals to portal vein and inferior vena cava (IVC)


Radiographic Findings



  • Radiography



    • Chest radiograph



      • Retrocardiac posterior mediastinal lobulated mass


      • ± mediastinal widening, abnormal azygoesophageal recess


  • Fluoroscopic-guided esophagography



    • Mucosal relief views



      • Tortuous, serpiginous, longitudinal radiolucent filling defects in collapsed or partially collapsed esophagus


    • Double-contrast study



      • Multiple radiolucent filling defects etched in white


    • Distended views of esophagus



      • Varices may be obscured


    • After sclerotherapy varices may appear as fixed, rigid filling defects


CT Findings

Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Esophageal Varices

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