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Gastrointestinal
Diagnosis
Esophagus
Vascular Disorders
Esophageal Varices
Esophageal Varices
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Dilated tortuous submucosal venous plexus of esophagus

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Li Y et al: Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients: a systematic review and meta-analysis. World J Gastroenterol. 26(18):2247-67, 2020
                                            2. Salahshour F et al: Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdom Radiol (NY). 45(8):2305-14, 2020
                                            3. Motosugi U et al: Four-dimensional flow MRI as a marker for risk stratification of gastroesophageal varices in patients with liver cirrhosis. Radiology. 290(1):101-7, 2019
                                            4. Manatsathit W et al: Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: systemic review and meta-analysis. J Gastroenterol Hepatol. 33(10):1696-706, 2018
                                            5. Aguilar-Olivos N et al: Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis. Ann Hepatol. 13(4):420-8, 2014
                                            6. Hong WD et al: Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study. BMC Gastroenterol. 9:11, 2009
                                            7. Sass DA et al: Portal hypertension and variceal hemorrhage. Med Clin North Am. 93(4):837-53, vii-viii, 2009
                                            8. Kang HK et al: Three-dimensional multi-detector row CT portal venography in the evaluation of portosystemic collateral vessels in liver cirrhosis. Radiographics. 22(5):1053-61, 2002
                                            9. Matsumoto A et al: Three-dimensional portography using multislice helical CT is clinically useful for management of gastric fundic varices. AJR Am J Roentgenol. 176(4):899-905, 2001
                                            10. Horton KM et al: Paraumbilical vein in the cirrhotic patient: imaging with 3D CT angiography. Abdom Imaging. 23(4):404-8, 1998
                                            11. Kishimoto R et al: Esophageal varices: evaluation with transabdominal US. Radiology. 206(3):647-50, 1998
                                            12. Lee SJ et al: Computed radiography of the chest in patients with paraesophageal varices: diagnostic accuracy and characteristic findings. AJR Am J Roentgenol. 170(6):1527-31, 1998
                                            13. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995
                                            14. Itai Y et al: CT and MRI in detection of intrahepatic portosystemic shunts in patients with liver cirrhosis. J Comput Assist Tomogr. 18(5):768-73, 1994
                                            15. Nelson RC et al: Splenic venous flow exceeding portal venous flow at Doppler sonography: relationship to portosystemic varices. AJR Am J Roentgenol. 161(3):563-7, 1993
                                            16. Balthazar EJ et al: CT evaluation of esophageal varices. AJR Am J Roentgenol. 148(1):131-5, 1987
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Dilated tortuous submucosal venous plexus of esophagus

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Angiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Li Y et al: Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients: a systematic review and meta-analysis. World J Gastroenterol. 26(18):2247-67, 2020
                                                                                      2. Salahshour F et al: Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdom Radiol (NY). 45(8):2305-14, 2020
                                                                                      3. Motosugi U et al: Four-dimensional flow MRI as a marker for risk stratification of gastroesophageal varices in patients with liver cirrhosis. Radiology. 290(1):101-7, 2019
                                                                                      4. Manatsathit W et al: Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: systemic review and meta-analysis. J Gastroenterol Hepatol. 33(10):1696-706, 2018
                                                                                      5. Aguilar-Olivos N et al: Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis. Ann Hepatol. 13(4):420-8, 2014
                                                                                      6. Hong WD et al: Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study. BMC Gastroenterol. 9:11, 2009
                                                                                      7. Sass DA et al: Portal hypertension and variceal hemorrhage. Med Clin North Am. 93(4):837-53, vii-viii, 2009
                                                                                      8. Kang HK et al: Three-dimensional multi-detector row CT portal venography in the evaluation of portosystemic collateral vessels in liver cirrhosis. Radiographics. 22(5):1053-61, 2002
                                                                                      9. Matsumoto A et al: Three-dimensional portography using multislice helical CT is clinically useful for management of gastric fundic varices. AJR Am J Roentgenol. 176(4):899-905, 2001
                                                                                      10. Horton KM et al: Paraumbilical vein in the cirrhotic patient: imaging with 3D CT angiography. Abdom Imaging. 23(4):404-8, 1998
                                                                                      11. Kishimoto R et al: Esophageal varices: evaluation with transabdominal US. Radiology. 206(3):647-50, 1998
                                                                                      12. Lee SJ et al: Computed radiography of the chest in patients with paraesophageal varices: diagnostic accuracy and characteristic findings. AJR Am J Roentgenol. 170(6):1527-31, 1998
                                                                                      13. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995
                                                                                      14. Itai Y et al: CT and MRI in detection of intrahepatic portosystemic shunts in patients with liver cirrhosis. J Comput Assist Tomogr. 18(5):768-73, 1994
                                                                                      15. Nelson RC et al: Splenic venous flow exceeding portal venous flow at Doppler sonography: relationship to portosystemic varices. AJR Am J Roentgenol. 161(3):563-7, 1993
                                                                                      16. Balthazar EJ et al: CT evaluation of esophageal varices. AJR Am J Roentgenol. 148(1):131-5, 1987