Downhill esophageal varices: a prevalent complication of superior vena cava obstruction from benign and malignant causes

J Comput Assist Tomogr. 2015 Mar-Apr;39(2):149-52. doi: 10.1097/RCT.0000000000000183.

Abstract

Objective: Downhill esophageal varices (DEV) usually develop secondary to superior vena cava (SVC) obstruction. Downhill esophageal varices have been less well characterized compared to uphill varices. The aim of the study was to characterize the anatomy and etiology of DEV by contrast-enhanced computed tomography.

Methods: Patients with SVC obstruction were included in the study. Downhill esophageal varices were defined as discrete esophageal submucosal or mucosal vessels. Ten random computed tomographic scans were assessed as controls.

Results: Downhill esophageal varices were seen in 11 of 36 patients. Three types of varices were observed. Between 1 and 6 varices were seen in each patient with a diameter of 1 to 5 mm.

Conclusions: Downhill esophageal varices can be seen in 30% of patients with SVC obstruction. They have several patterns and are mostly systemic-to-systemic collaterals. The most common etiology associated with DEV is renal failure. Downhill esophageal varices are of small caliber, this may in part account for less frequent bleeding compared to uphill varices.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media
  • Esophageal and Gastric Varices / diagnostic imaging*
  • Esophageal and Gastric Varices / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Superior Vena Cava Syndrome / complications*
  • Superior Vena Cava Syndrome / etiology
  • Tomography, X-Ray Computed* / methods
  • Young Adult

Substances

  • Contrast Media