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Esophageal varices
Uphill
cause bleeding
from portal HTN (reversal of flow uphill from portal vein > left
gastric > periesophageal venous plexus > azygous and
hemiazygous collaterals > SVC)
collapsing, long serpentine filling defects in the distal esophagus
on UGI study; differentiate from varicoid carcinoma
Downhill
asymptomatic
obstruction of SVC > collateral enlargement in supreme
intercostal, bronchial and inferior thyroid veins
tubular thickened folds in upper thoracic esophgus
look for reason for SVC syndrome (bronchogenic carcinoma,
lymphoma, or fibrosing mediastinitis)

History: 50 year old male with chronic lower back pain.

Radiographic differential
diagnosis includes:

- simple bone cyst

- central location (unlike ABC)
- absence of expansion
- lack of cortical discontinuity
- giant cell tumor of bone
- occurs in patients over age 20
- lack of expansion
- begin in epiphysis with extension into metaphysis
- more likely to be centrally located
- telangiectatic osteosarcoma
- difficult to distinguish radiographically from an aggressive ABC
- angiosarcoma.
- osteoblastoma
- may have a soap bubble expansile appearance
- no fluid level on CT/MR

Terima
kasih