• Transjugular intrahepatic portosystemic shunt (TIPS) provides more physiological means of treating varices and ascites than other surgical procedures
(Left) Graphic shows dilated, tortuous, submucosal collateral veins (varices) within the wall of the esophagus.
(Right) Double-contrast esophagram shows tortuous, nodular longitudinal folds, typical of varices. These are unusually well depicted, even with the esophageal lumen distended, suggesting that the varices may be thrombosed or sclerosed by endoscopic injection.
(Left) Axial CECT in a 55-year-old man with upper GI bleeding shows large esophageal varices .
(Right) Esophagram in the same patient performed after endoscopic sclerosis of the varices shows fixed filling defects in the esophageal wall and lumen. The fixed nature of these mimics the appearance of the “varicoid” morphology of some esophageal carcinomas.
TERMINOLOGY
Definitions
• Dilated tortuous submucosal venous plexus of esophagus
IMAGING
General Features
• Best diagnostic clue
Tortuous or serpiginous longitudinal filling defects on esophagography
• Location
Uphill varices: Distal 1/3 or 1/2 of esophagus (more common)
Downhill varices: Upper or middle 1/3 of esophagus (less common)
• Morphology
Tortuous dilated veins in long axis of esophagus, protruding directly beneath mucosa or in periesophageal tissue
• Other general features
Usually due to portal hypertension (HTN) with cirrhosis or other liver diseases
Idiopathic varices: In patients with no portal HTN or superior vena cava (SVC) block (very rare)
Classification of esophageal varices based on pathophysiology
– Uphill varices: ↑ portal venous pressure → upward venous flow via dilated esophageal collaterals to SVC
– Downhill varices: Obstruction of SVC → downward venous flow via esophageal collaterals to portal vein and inferior vena cava (IVC)
Radiographic Findings
• Radiography
Chest radiograph
– Retrocardiac posterior mediastinal lobulated mass
.
in the esophageal wall and lumen. The fixed nature of these mimics the appearance of the “varicoid” morphology of some esophageal carcinomas.
