Downhill Varices: Report of a Case 29 Years After Resection of a Substernal Thyroid Gland

Sorokin, Jeffrey J.; Levine, Stephen M.; Moss, Edward G.; Biddle, Caitlin

doi:10.1016/s0016-5085(19)32223-1

Cited by 21 publications

(12 citation statements)

References 5 publications

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“…However, a systematic review of individuals with atrial fibrillation receiving dialysis found similar efficacy in preventing venous thromboembolic events with direct oral anticoagulants (DOACs) versus warfarin [51]. Some of the other predisposing factors that are found less happened included retrosternal thyroids [16,21,23,40,41], Behçet's disease [6,22,32,42] and pulmonary hypertension [7,24,25,34]. Downhill varices in retrosternal goiter develop due to a similar obstruction in the thyroid veins resulting in the blood re-routing via the deep esophageal veins [16].…”

Section: Discussionmentioning

confidence: 99%

Downhill esophageal varices: a systematic review of the case reports

Ali

Pamarthy

Bolick

et al. 2022

Exploration of Medicine

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Aim: The etiologies, presentation, and management of downhill varices in the era of modern medicine are relatively under-explored and mostly limited to case reports or case series. Methods: Published case reports/series of patients ≥ 18 years old with proven/probable downhill esophageal varices were searched on Ovid MEDLINE and Ovid EMBASE for all published cases up to January 2021. Results: The mean age was 50.9 (standard deviation ± 17.6) years old for all downhill variceal cases. End-stage renal disease was the most common comorbidity (43.9%), followed by thyroid disease (12.2%), Behçet’s disease (9.8%), and pulmonary hypertension (7.3%). Dialysis catheters, central venous grafts, or additional catheters were additional risk factors (51.2%). Variceal bleeding presenting as hematemesis, melena, or both was the most common presenting symptom (80.5%). Conclusions: Dialysis catheter-associated superior vena cava obstruction resulted in an increased risk of downhill varices. Other causes include thyroid malignancies, pulmonary hypertension, and Behçet’s disease.

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Section: Discussionmentioning

confidence: 99%

Downhill esophageal varices: a systematic review of the case reports

Ali

Pamarthy

Bolick

et al. 2022

Exploration of Medicine

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“…They are dilated veins resulting from SVC obstruction whose blood flow is directed caudally towards azygous vein [12] or inferior vena cava (IVC). They are either located in the upper esophagus or may involve the entire esophagus depending on the level of obstruction above or below azygous venous system, respectively [13–15]. Various neoplastic lesions involving neck and thorax have been reported to cause SVC compression leading to “downhill” varices [16].…”

Section: Discussionmentioning

confidence: 99%

“Downhill” Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding

Nayudu

Dev

Kanneganti

2013

Case Reports in Gastrointestinal Medicine

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“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed “downhill” varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare “downhill” varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.

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“…If the superior vena cava is obstructed above the azygos vein, the blood returns to the heart through this vein via mediastinal collaterals, and varices ultimately develop in the upper part of the esophagus. Obstruction of the superior vena cava below the azygos vein results in blood returning to the heart via the inferior vena cava through the hemiazygos, esophageal, and portal veins, in which case varices arise along the length of the esophagus [6,7,11]. There is a published report of downhill varices associated with a mediastinal mass in which cavography showed no obstruction of the superior vena cava [2].…”

Section: Discussionmentioning

confidence: 99%

“…To date, more than 100 cases of downhill esophageal varices with various causes have been described in the literature. In cases of a mediastinal tumor, varices sometimes arise along the entire length of the esophagus instead of in the downhill configuration [3,6,7]. We report a case in which varices were detected in the distal half of the esophagus, and were related to a mediastinal mass.…”

Section: Introductionmentioning

confidence: 99%

A Case of Castleman’s Disease with ”Downhill” Varices in the Absence of Superior Vena Cava Obstruction

Serin

Özer²,

Gümürdülü³

et al. 2002

Endoscopy

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Downhill esophageal varices", classically defined as those that develop in the upper region of the esophagus, are less common than the "uphill" type, which is usually produced by portal hypertension. Various causes of downhill varices have been reported, but mediastinal tumor is the most common responsible lesion. Castleman's disease, or angiofollicular lymph node hyperplasia, is a rare pathological process of unknown etiology that usually develops in the mediastinum. We report the case of a 60-year-old woman whose large esophageal varices were detected incidentally. The cause was a mediastinal mass which was diagnosed as Castleman's disease on histopathological examination of a surgical specimen. This patient's varices most likely formed as a result of copious blood drainage from the tumor into the esophageal veins. Evidence for this was the lack of the classic downhill pattern, the absence of superior vena cava obstruction, and the fact that the varices resolved after the tumor was removed. It is our opinion that this type of varices should be renamed, and we suggest that "overflow varices" would be an appropriate term.

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Downhill Varices: Report of a Case 29 Years After Resection of a Substernal Thyroid Gland

Cited by 21 publications

References 5 publications

Downhill esophageal varices: a systematic review of the case reports

Downhill esophageal varices: a systematic review of the case reports

“Downhill” Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding

A Case of Castleman’s Disease with ”Downhill” Varices in the Absence of Superior Vena Cava Obstruction

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