Laryngeal varices: an atypical cause of globus

Ringrose, T; Patel, Jamie; Ghasemi, Aria Amir

doi:10.1136/bcr-2021-246413

Cited by 4 publications

(2 citation statements)

References 4 publications

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“…In 10 of those 12 cases, excluding one case treated using esophageal balloon tamponade 10 and one case treated with sclerotherapy 16 , the varices resolved after thyroidectomy. Similar to the present case, there is also report of downhill varices that was detected without bleeding 20 .…”

Section: Discussionsupporting

confidence: 90%

Downhill Varices in the Hypopharynx of a Patient with a Large Thyroid Tumor: A Case Report

et al. 2023

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Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures show retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man visited a local hospital with a 35-year history of enlarging thyroid tumor in the right neck. Fine needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13105 cm) in the right to left lobe of the thyroid extending into the mediastinum. Further, a well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination demonstrated varices in the postcricoid region, so we avoided biopsy. The preoperative diagnosis was huge adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, in this case, signs of SVC obstruction were absent and varices were found not in the upper esophagus, but in the hypopharynx. Obstructed venous flow from the thyroid plexus might circulate via superior laryngeal vein and cause varices in the postcricoid region. When a patient with large mediastinal tumor shows a tumor-like lesion

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Section: Discussionsupporting

confidence: 90%

Downhill Varices in the Hypopharynx of a Patient with a Large Thyroid Tumor: A Case Report

et al. 2023

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“…While it had been previously reported that this syndrome was more often associated with malignancy, this remains unproven 21 . Isolated dysphagia is also possible in case of goiter growing only in the retro-esophageal plane 32,33 , while the only presenting symptom may also be represented by oropharyngeal bleeding because of pharyngolaryngeal "downhill" (i.e ., without venous portal hypertension) varices 34 . Furthermore lower and upper extremities edema 35 , pericardial effusion, chylothorax, or hemoptysis because of tracheal varices have been also described 21 .…”

Section: Clinical Presentationmentioning

confidence: 99%

A critical update on the management of retrosternal goiter

Miani,

Locatello,

Bergamin-Bracale

et al. 2023

Preprint

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Background: Retrosternal goiters (RGs) pose several challenges to head and neck surgeons because of the intricate anatomical relationships with major vessels and other mediastinal structures. Methods: A scoping review of the last five years in the PubMed database was conducted and a total of 105 articles were discussed, along with methodological issues and future directions in the research on RGs. Results: The surgical excision of RGs may be accomplished by standard transcervical approach in the vast majority of cases, yet the potential need for a transthoracic approach must be always kept in mind. Great expertise in referral centers is required to maintain an acceptable rate of postoperative complications, and a thorough diagnostic work-up is mandatory. Several non-surgical treatments in addition to mini-invasive approaches have been proposed for RGs. Conclusions: RGs require a multidisciplinary thyroid team in order to eventually minimize the risk of complications and avoid extracervical approaches.

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