Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Case 1 Tracheal diverticulum/paratracheal air cysts
- Case 2 Tracheal bronchus
- Case 3 Relapsing polychondritis
- Case 4 Tracheobronchopathia osteochondroplastica
- Case 5 Tracheobronchomegaly
- Case 6 Bronchial atresia
- Case 7 Dysmotile cilia syndrome (Kartagener's)
- Case 8 Williams-Campbell syndrome
- Case 9 Horseshoe lung
- Case 10 Sarcoidosis
- Case 11 Lymphangioleiomyomatosis (LAM)
- Case 12 Pulmonary Langerhans cell histiocytosis
- Case 13 Transbronchial biopsy lung injury
- Case 14 Congenital cystic adenomatoid malformation
- Case 15 Lymphocytic interstitial pneumonia
- Case 16 Intralobar sequestration
- Case 17 Erdheim-Chester disease
- Case 18 Exogenous lipoid pneumonia
- Case 19 Pulmonary alveolar proteinosis
- Case 20 Alveolar microlithiasis
- Case 21 Metastatic pulmonary calcification
- Case 22 Pulmonary hamartoma
- Case 23 Carney's triad/pulmonary chondromas
- Case 24 Mycobacterium avium-intracellulare complex (MAC) infection
- Case 25 Mycetoma
- Case 26 Rounded atelectasis
- Case 27 Pneumomediastinum
- Case 28 Fibrosing mediastinitis
- Case 29 Extramedullary hematopoiesis
- Case 30 Thymolipoma
- Case 31 Mature teratoma
- Case 32 Mediastinal bronchogenic cyst
- Case 33 Lateral meningoceles
- Case 34 Peripheral nerve sheath tumors
- Case 35 Fibrovascular polyp
- Case 36 Duplication cyst
- Case 37 Pulsion (epiphrenic) diverticulum
- Case 38 Traction diverticulum
- Case 39 Esophageal downhill varices
- Case 40 Esophageal uphill varices
- Case 41 Esophageal mural thickening
- Case 42 Esophageal dilatation
- Case 43 Penetrating atheromatous ulcer
- Case 44 Intramural hematoma
- Case 45 Aortic dissection
- Case 46 Aortic transection
- Case 47 Coarctation and pseudocoarctation of the aorta
- Case 48 Double aortic arch
- Case 49 Right aortic arch
- Case 50 Pulmonary sling
- Case 51 Takayasu's arteritis
- Case 52 Unilateral absence of a pulmonary artery (UAPA)
- Case 53 Partial anomalous pulmonary venous return (PAPVR)
- Case 54 Pulmonary arteriovenous malformations (PAVMs)
- Case 55 Pulmonary artery sarcoma
- Case 56 Intravascular tumor emboli
- Case 57 Pulmonary veno-occlusive disease
- Case 58 Persistent left SVC
- Case 59 SVC syndrome
- Case 60 Prominent superior intercostal vein
- Case 61 Azygos continuation of the IVC
- Case 62 Recesses of the pericardium
- Case 63 Pericardial effusion
- Case 64 Pericardial cysts
- Case 65 Partial or complete absence of the pericardium
- Case 66 Pleural lipoma
- Case 67 Prominent subpleural fat with chronic pleural disease
- Case 68 Benign fibrous tumor of the pleura (+/− pedicles)
- Case 69 Talc pleurodesis
- Case 70 Morgagni hernia
- Case 71 Bochdalek hernia
- Case 72 Prominent cysterna chyli
- Case 73 Diffuse pulmonary lymphangiomatosis
- Case 74 Lymphangitic carcinomatosis
- Case 75 Pulmonary nodule misregistration on PET/CT
- Case 76 Hot clot artifact
- Case 77 Brown fat on PET/CT
- Case 78 Pulmonary Langerhans cell histiocytosis on PET/CT
- Case 79 Talc pleurodesis on PET/CT
- Case 80 Esophagitis on PET/CT
- Case 81 Takayasu's arteritis on PET/CT
- Case 82 Window and level settings
- Case 83 Stair step artifacts
- Case 84 Streak artifacts
- Case 85 Respiratory motion
- Case 86 Lung reconstruction algorithm
- Index
- References
Case 39 - Esophageal downhill varices
Published online by Cambridge University Press: 07 October 2011
- Frontmatter
- Contents
- Contributors
- Preface
- Case 1 Tracheal diverticulum/paratracheal air cysts
- Case 2 Tracheal bronchus
- Case 3 Relapsing polychondritis
- Case 4 Tracheobronchopathia osteochondroplastica
- Case 5 Tracheobronchomegaly
- Case 6 Bronchial atresia
- Case 7 Dysmotile cilia syndrome (Kartagener's)
- Case 8 Williams-Campbell syndrome
- Case 9 Horseshoe lung
- Case 10 Sarcoidosis
- Case 11 Lymphangioleiomyomatosis (LAM)
- Case 12 Pulmonary Langerhans cell histiocytosis
- Case 13 Transbronchial biopsy lung injury
- Case 14 Congenital cystic adenomatoid malformation
- Case 15 Lymphocytic interstitial pneumonia
- Case 16 Intralobar sequestration
- Case 17 Erdheim-Chester disease
- Case 18 Exogenous lipoid pneumonia
- Case 19 Pulmonary alveolar proteinosis
- Case 20 Alveolar microlithiasis
- Case 21 Metastatic pulmonary calcification
- Case 22 Pulmonary hamartoma
- Case 23 Carney's triad/pulmonary chondromas
- Case 24 Mycobacterium avium-intracellulare complex (MAC) infection
- Case 25 Mycetoma
- Case 26 Rounded atelectasis
- Case 27 Pneumomediastinum
- Case 28 Fibrosing mediastinitis
- Case 29 Extramedullary hematopoiesis
- Case 30 Thymolipoma
- Case 31 Mature teratoma
- Case 32 Mediastinal bronchogenic cyst
- Case 33 Lateral meningoceles
- Case 34 Peripheral nerve sheath tumors
- Case 35 Fibrovascular polyp
- Case 36 Duplication cyst
- Case 37 Pulsion (epiphrenic) diverticulum
- Case 38 Traction diverticulum
- Case 39 Esophageal downhill varices
- Case 40 Esophageal uphill varices
- Case 41 Esophageal mural thickening
- Case 42 Esophageal dilatation
- Case 43 Penetrating atheromatous ulcer
- Case 44 Intramural hematoma
- Case 45 Aortic dissection
- Case 46 Aortic transection
- Case 47 Coarctation and pseudocoarctation of the aorta
- Case 48 Double aortic arch
- Case 49 Right aortic arch
- Case 50 Pulmonary sling
- Case 51 Takayasu's arteritis
- Case 52 Unilateral absence of a pulmonary artery (UAPA)
- Case 53 Partial anomalous pulmonary venous return (PAPVR)
- Case 54 Pulmonary arteriovenous malformations (PAVMs)
- Case 55 Pulmonary artery sarcoma
- Case 56 Intravascular tumor emboli
- Case 57 Pulmonary veno-occlusive disease
- Case 58 Persistent left SVC
- Case 59 SVC syndrome
- Case 60 Prominent superior intercostal vein
- Case 61 Azygos continuation of the IVC
- Case 62 Recesses of the pericardium
- Case 63 Pericardial effusion
- Case 64 Pericardial cysts
- Case 65 Partial or complete absence of the pericardium
- Case 66 Pleural lipoma
- Case 67 Prominent subpleural fat with chronic pleural disease
- Case 68 Benign fibrous tumor of the pleura (+/− pedicles)
- Case 69 Talc pleurodesis
- Case 70 Morgagni hernia
- Case 71 Bochdalek hernia
- Case 72 Prominent cysterna chyli
- Case 73 Diffuse pulmonary lymphangiomatosis
- Case 74 Lymphangitic carcinomatosis
- Case 75 Pulmonary nodule misregistration on PET/CT
- Case 76 Hot clot artifact
- Case 77 Brown fat on PET/CT
- Case 78 Pulmonary Langerhans cell histiocytosis on PET/CT
- Case 79 Talc pleurodesis on PET/CT
- Case 80 Esophagitis on PET/CT
- Case 81 Takayasu's arteritis on PET/CT
- Case 82 Window and level settings
- Case 83 Stair step artifacts
- Case 84 Streak artifacts
- Case 85 Respiratory motion
- Case 86 Lung reconstruction algorithm
- Index
- References
Summary
Imaging description
Mid and upper esophageal (downhill) varices cause nonspecific thickening of the esophageal wall by CT chest without intravenous contrast material. These varices enhance after intravenous contrast material administration. Periesophageal varices are often present as well. Downhill varices are diagnosed by their location and by the associated signs of superior vena cava (SVC) obstruction (Figure 39.1). They are often smaller than distal esophageal uphill varices.
Importance
Downhill esophageal varices result from SVC obstruction; they are much less common than uphill varices secondary to cirrhosis and portal venous hypertension. Obstruction of the SVC often results from thrombosis and a common cause of SVC thrombosis is chronic catheterization. Other causes of SVC obstruction are mediastinal metastases, lymphoma, substernal goiter, mediastinal radiation, and sclerosing mediastinitis [1]. Blood bypasses the obstructed SVC by flowing inferiorly through esophageal and periesophageal veins into the inferior vena cava or into the portal circulation. Downhill varices are only one of many collateral pathways that blood can follow to return to the heart when the SVC is occluded; azygos, hemiazygos, and chest wall veins provide other collateral pathways. Therefore, the volume of blood flowing through downhill varices is typically less than the volume of blood flowing through uphill varices. Consequently, downhill varices tend to be smaller than uphill varices and are less likely to bleed than uphill varices.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Thoracic ImagingVariants and Other Difficult Diagnoses, pp. 96 - 97Publisher: Cambridge University PressPrint publication year: 2011