The Pandora's Box of Downhill Varices

A 67-year-old man presented with complaints of gradually progressive difficulty swallowing for 1 month. The swallowing difficulty was more for solid than for liquid. Over the last 2 weeks, the patient also complained of chest pain, anorexia, and weight loss. His general physical examination and basic laboratory investigation were normal. His esophagogastroduodenoscopy revealed downhill varices with luminal narrowing due to extrinsic impression extending from 25 to 29 cm from incisor with normal overlying mucosa ([Fig. 1]). His contrast-enhanced computed tomography of the chest revealed a heterogeneously enhancing lesion in the superior segment of the right lower lobe with mediastinal lymphadenopathy with central necrotic area near the carinal bifurcation encasing the esophagus with significant luminal compromise causing mild upstream dilatation of esophagus ([Fig. 2]). Ultrasound-guided biopsy from the lung lesion was done and histopathological examination revealed it to be adenocarcinoma of the lung.

Fig. 1 Esophagogastroduodenoscopy image showing large varices in the proximal and middle third of the esophagus with no bleeding stigmata (yellow arrow).

Fig. 2 (A) Sagittal section of computed tomography showing mediastinal lymphadenopathy in prevertebral region (yellow arrow). (B) Cross-sectional computed tomography image showing heterogeneously enhancing lung lesion in the superior segment of the right lower lobe (orange arrow) with necrotic mediastinal lymphadenopathy at the level of carinal bifurcation (yellow arrow).

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The patient provided informed consent to publish the included information.

Publikationsverlauf

Artikel online veröffentlicht:
06. November 2024

• References

• 1 Chakinala RC, Kumar A, Barsa JE. et al. Downhill esophageal varices: a therapeutic dilemma. Ann Transl Med 2018; 6 (23) 463
• 2 Nemat H, Gupta V, Abbasi U, Gorantla S, David J, Cowan J, Culpepper-Morgan J. A case of downhill esophageal varices: a rare cause of upper gastrointestinal bleeding. Am J Gastroenterol 2010; 105: S378-S379
• 3 Pelot D, Reynolds JC. Anatomy, anomalies, and physiology of the esophagus. Bockus Gastroenterol 1995; 1: 397-411