Paraesophageal Varices

Physiology

  • Portal HTN (of any etiology) -> distention of paraesophageal veins
  • Paraesophageal veins empty into the coronary (left gastric)/ azygous/ hemiazygous veins as well as the vertebral plexus

Diagnosis

  • CXR/Chest CT patterns: may appear as a mediastinal mass/retrocardiac mass (in 4.8% of patients with portal HTN)
    • CT (even without contrast) demonstrates “serpentine” appearance of veins
  • FNA: may be hazardous

Clinical

  • Posterior Mediastinal Mass (see [[Mediastinal Mass]])

Treatment

  • Banding or Sclerotherapy
    • EUS can be used to visualize paraesophageal and gastric varices after sclerotherapy or banding ligation
    • Paraesophageal varices were more frequently noted in patients undergoing ligation
    • The presence of paraesophageal varices may predict the recurrence of esophageal varices and recurrent bleeding
  • TIPSS

References

  • Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc. 1999 Apr;49(4 Pt 1):428-36
  • Paraesophageal varices presenting as a retrocardiac mediastinal mass. A case report. Acta Radiol. 1994 May;35(3):255-7