Review

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