CHAPTER I INTRODUCTION Approximately 90% of patients with cirrhosis will have developed esophageal varices within 10 geal variceal ha. Esophageal varices are enlarged or swollen veins that occur on the lining of the esophagus. Varices can be life-threatening if they break open and bleed. Mucosal relief views of the esophagus can reveal serpiginous filling defects seen after the passage of barium via the peristaltic wave. Varices may also be.

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In review case studies, a single varisess esophageal varix may be confused with an esophageal mass on barium studies. Splenic vein thrombosis is a rare condition that causes esophageal varices without a raised portal pressure.

Uphill esophageal varices on mucosal relief barium swallow. Need a Curbside Consult?

Barium swallow examination is not a sensitive test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention. A variety of techniques have been described for the CT evaluation of the portal venous system. Detection is slightly better with variss percutaneous technique, but it potentially creates more morbidity than the indirect method.

Type 1 — Partial occlusion of the SVC with patency of the azygous vein. If the SVC obstruction occurs above the level of the azygos vein, the downhill varices are confined to the upper or midthoracic esophagus because the varices can return blood from the head and upper extremities to farises SVC via the azygos vein.

Grade vaarises — Large, coil-shaped esophageal varices occupying more than one third of the lumen. Duodenal varice noted on endoscopic exam.


In patients with varices due to alcohol, continuing to drink increases the risk of bleeding. CT scans also help in evaluating the liver, other venous collaterals, details of other surrounding anatomic structures, and the patency of the portal vein.

In situations where portal pressures increase, such as with cirrhosisthere is dilation of veins in the anastomosisleading to esophageal varices. Detection of paraesophageal varices by plain films. Maximum intensity projection magnetic resonance image of the portal venous system demonstrates extensive esophageal varices arrows in conjunction with splenic and gastric varices. This sign, in conjunction with thickened folds with rounded expansions and some degree of distensibility, is pathognomonic for esophageal varices.

In the setting of SVC obstruction, the most common collateral pathways were the in decreasing order of frequency: Superior vena cava obstruction: CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation. This content does not have an English version.

Esophageal Varices

If you lose enough blood, you can go into shock, which can lead to death. Esophageal varices develop when normal blood flow to the liver is blocked by a esotagus or scar tissue in the liver. Before the advent of flexible endoscopy, angiography was the criterion standard in diagnosing esophageal varices. The higher the portal pressure, the greater the risk of bleeding.

They usually occur in people with cirrhosis of the liver. The advantage of MRI over CT scanning in evaluating downhill esophageal varices is its superior ability in evaluating soft tissues. Internal bleedinghypovolemic shockcardiac arrest.

The images demonstrate all 5 layers of the esophagus, in alternating echogenic and hypoechoic layers, starting with the echogenic mucosa.


Esophageal varices – Symptoms and causes – Mayo Clinic

On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature.

Spectral Doppler and Color Doppler ultrasound show perihilar white arrow and peripancreatic varices black arrow.

Evaluation of the portal venous system: Diseases of the digestive system primarily K20—K93— Iodinated esofagjs material or carbon dioxide may be injected through a catheter wedged in a hepatic vein to obtain digital subtraction DSA images of the hepatic venous system and, possibly, the portal venous system in hepatofugal flow.

Pay attention to technique to optimize detection of esophageal varices. This page was last edited on 25 Octoberat Improved images can be obtained by using a contrast-enhanced, breath-hold, fat-saturated, segmented, 3-dimensional 3-Dgradient-echo technique.

On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus. Downhill varices are often asymptomatic, but may cause vwrises hematemesis or low-grade gastrointestinal bleeding.

The images are reconstructed in 5-mm increments. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not available see the images below. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it progresses caudally.