‘Downhill’ Varices as a Surrogate Marker for Mediastinal or Lung Pathology: A Case Report
Keywords:
Esophagogastroduodenoscopy, Red color sign, Contrast Enhanced Computed Tomography, Endoscopic Band Ligation.
Abstract
‘Downhill’ varices are dilated veins resulting from SVC obstruction whose blood flow is directed caudally towards azygous vein or inferior vena cava. Their etiology differs from that of the usual “uphill” varices secondary to portal hypertension. We report a case of 63 year old male that was suspected to have mediastinal / lung pathology based on finding of downhill varix on diagnostic esophagogastroduodenoscopy despite normal chest X- ray. Subsequently, the lung pathology was confirmed on contrast enhanced tomography of chest and on bronchoscopy. So findings of ‘downhill’varices on endoscopy can suggest lung/medistinal pathology which needs to be confirmed on subsequent testing.References
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10. Vorlop E, Zaidman J, Moss SF. Clinical challenges and images in GI. Downhill esophageal varices secondary to superior vena cava occlusion. Gastroenterology.2008; 135(6): 1863, 2158.
2. Rosenblatt ML, Rabinowitz M. Downhill esophageal varices (EV) secondary to fibrosingmediastinitis. (FM) AJG. 2000; 95:2602-03.
3. Basaranoglu M, Ozdemir S, Celik AF, Senturk H, Akin P. A case of fibrosingmediastinitis with obstruction of superior vena cava and “downhill” esophageal varices: a rare cause of upper gastrointestinal hemorrhage. J ClinGastroenterol. 1999; 28(3):268-70.
4. Johnson L.S, Kinnear D.G, Brown R.A, Mulder D.S., “Downhill” esophageal varices. A rare cause of upper gastrointestinal bleeding. Archives of Surgery. 1978; 113(12):1463–
1464.
5. Sorokin J.J, Levine S.M, Moss E.G, Biddle C.M. “Downhill varices: report of a case 29 years after resection of a substernal thyroid gland. Gastroenterology. 1977; 73(2):345–348.
6. Georges EL Jammal. An unusual case of Esophageal Varices: “Downhill” type. Gastroenterology and Hepatology. 2015; 2:3.
7. Papazian A, Capron JP, Rémond A, Descombes P, Ringot PL. Upper esophageal varices: a study of 6 cases and review of the literature. Gastroenterol Clin Biol. 1983; 7(11): 903-910.
8. Tavakkoli H, Asadi M, Haghighi M, Esmaeili A. Therapeutic approach to downhill esophageal varices bleeding due to superior vena cava syndrome in Behcet’s disease: a case report. BMC Gastroenterol. 2006 ; 6: 43.
9. Areia M, Romãozinho JM, Ferreira M, Amaro P, Freitas D. Unidadede Cuidados Intensivos de Gastrenterologia – 13 anos de vida. GE-J Port Gastrenterol. 2005; 12(3): 62.
10. Vorlop E, Zaidman J, Moss SF. Clinical challenges and images in GI. Downhill esophageal varices secondary to superior vena cava occlusion. Gastroenterology.2008; 135(6): 1863, 2158.
Published
2020-10-27
How to Cite
Dr. Vishal Bodh, Dr. Brij Sharma, Dr. Rajesh Sharma, Dr. Rajesh Kumar. (2020). ‘Downhill’ Varices as a Surrogate Marker for Mediastinal or Lung Pathology: A Case Report. The Indian Practitioner, 73(10), 26-28. Retrieved from http://articles.theindianpractitioner.com/index.php/tip/article/view/1066
Section
Case Reports
