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