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
