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Chest
Diagnosis
Mediastinal Abnormalities
Vascular Lesions
Paraesophageal Varices
Paraesophageal Varices
John P. Lichtenberger, III, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Dilated vessels within (esophageal) or adjacent to (paraesophageal) esophageal wall
                • Uphill varices: Lower mediastinum, usually from portal hypertension
                • Downhill varices: Upper mediastinum usually from superior vena cava obstruction

              IMAGING

              • General Features

                • Radiographic Findings

                  • Fluoroscopic Findings

                    • CT Findings

                      • MR Findings

                        • Ultrasonographic Findings

                          • Angiographic Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Staging, Grading, & Classification

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Manchec B et al: Contrast-enhanced CT may identify high-risk esophageal varices in patients with cirrhosis. AJR Am J Roentgenol. 215(3):617-23, 2020
                                                2. Pham JT et al: Quantitative CT predictors of portal venous intervention in uncontrolled variceal bleeding. AJR Am J Roentgenol. 215(5):1247-51, 2020
                                                3. Zhao LQ et al: Characteristics of paraesophageal varices: a study with 64-row multidetector computed tomography portal venography. World J Gastroenterol. 14(34):5331-5, 2008
                                                4. Kim SH et al: Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology. 242(3):759-68, 2007
                                                5. Tesdal IK et al: Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding. Radiology. 236(1):360-7, 2005
                                                6. Bhasin DK et al: Variceal bleeding and portal hypertension: new lights on old horizon. Endoscopy. 36(2):120-9, 2004
                                                7. De Franchis R: Incidental esophageal varices. Gastroenterology. 126(7):1860-7, 2004
                                                8. Lo GH et al: The characteristics and the prognosis for patients presenting with actively bleeding esophageal varices at endoscopy. Gastrointest Endosc. 60(5):714-20, 2004
                                                9. Tamano M et al: Evaluation of esophageal varices using contrast-enhanced coded harmonic ultrasonography. J Gastroenterol Hepatol. 19(5):572-5, 2004
                                                10. Matsuo M et al: Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage. AJR Am J Roentgenol. 180(2):461-6, 2003
                                                11. Miller L et al: Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol. 98(2):454-9, 2003
                                                12. Irisawa A et al: Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy. Gastrointest Endosc. 56(2):249-53, 2002
                                                13. Cihangiroglu M et al: Collateral pathways in superior vena caval obstruction as seen on CT. J Comput Assist Tomogr. 25(1):1-8, 2001
                                                14. Lawler LP et al: Pericardial varices: depiction on three-dimensional CT angiography. AJR Am J Roentgenol. 177(1):202-4, 2001
                                                15. Chalasani N et al: Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol. 94(11):3285-91, 1999
                                                16. Shimizu T et al: Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT. Eur Radiol. 9(8):1546-9, 1999
                                                17. 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
                                                18. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995
                                                19. Ishikawa T et al: Detection of paraesophageal varices by plain films. AJR Am J Roentgenol. 144(4):701-4, 1985
                                                20. Hirose J et al: "Downhill" esophageal varices demonstrated by dynamic computed tomography. J Comput Assist Tomogr. 8(5):1007-9, 1984
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Definitions

                                                              • Dilated vessels within (esophageal) or adjacent to (paraesophageal) esophageal wall
                                                              • Uphill varices: Lower mediastinum, usually from portal hypertension
                                                              • Downhill varices: Upper mediastinum usually from superior vena cava obstruction

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • Fluoroscopic Findings

                                                                  • CT Findings

                                                                    • MR Findings

                                                                      • Ultrasonographic Findings

                                                                        • Angiographic Findings

                                                                          • Imaging Recommendations

                                                                            DIFFERENTIAL DIAGNOSIS

                                                                              PATHOLOGY

                                                                              • General Features

                                                                                • Staging, Grading, & Classification

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Manchec B et al: Contrast-enhanced CT may identify high-risk esophageal varices in patients with cirrhosis. AJR Am J Roentgenol. 215(3):617-23, 2020
                                                                                              2. Pham JT et al: Quantitative CT predictors of portal venous intervention in uncontrolled variceal bleeding. AJR Am J Roentgenol. 215(5):1247-51, 2020
                                                                                              3. Zhao LQ et al: Characteristics of paraesophageal varices: a study with 64-row multidetector computed tomography portal venography. World J Gastroenterol. 14(34):5331-5, 2008
                                                                                              4. Kim SH et al: Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology. 242(3):759-68, 2007
                                                                                              5. Tesdal IK et al: Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding. Radiology. 236(1):360-7, 2005
                                                                                              6. Bhasin DK et al: Variceal bleeding and portal hypertension: new lights on old horizon. Endoscopy. 36(2):120-9, 2004
                                                                                              7. De Franchis R: Incidental esophageal varices. Gastroenterology. 126(7):1860-7, 2004
                                                                                              8. Lo GH et al: The characteristics and the prognosis for patients presenting with actively bleeding esophageal varices at endoscopy. Gastrointest Endosc. 60(5):714-20, 2004
                                                                                              9. Tamano M et al: Evaluation of esophageal varices using contrast-enhanced coded harmonic ultrasonography. J Gastroenterol Hepatol. 19(5):572-5, 2004
                                                                                              10. Matsuo M et al: Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage. AJR Am J Roentgenol. 180(2):461-6, 2003
                                                                                              11. Miller L et al: Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol. 98(2):454-9, 2003
                                                                                              12. Irisawa A et al: Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy. Gastrointest Endosc. 56(2):249-53, 2002
                                                                                              13. Cihangiroglu M et al: Collateral pathways in superior vena caval obstruction as seen on CT. J Comput Assist Tomogr. 25(1):1-8, 2001
                                                                                              14. Lawler LP et al: Pericardial varices: depiction on three-dimensional CT angiography. AJR Am J Roentgenol. 177(1):202-4, 2001
                                                                                              15. Chalasani N et al: Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol. 94(11):3285-91, 1999
                                                                                              16. Shimizu T et al: Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT. Eur Radiol. 9(8):1546-9, 1999
                                                                                              17. 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
                                                                                              18. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995
                                                                                              19. Ishikawa T et al: Detection of paraesophageal varices by plain films. AJR Am J Roentgenol. 144(4):701-4, 1985
                                                                                              20. Hirose J et al: "Downhill" esophageal varices demonstrated by dynamic computed tomography. J Comput Assist Tomogr. 8(5):1007-9, 1984