Retrosternal goitre presenting as bleeding oesophageal varices.

Barber, Philip; Edwards, Joseph; Enoch, B. A.; Shafiq, Mahwash Anjum; Vallon, A G

doi:10.1136/bmj.1.6009.564

Cited by 3 publications

(1 citation statement)

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“…Third, because distal uphill varices predominantly distend subepithelial levels compared to the submucosal location of downhill varices in the midthoracic and proximal esophageal wall, variceal rupture is much more likely to occur near the esophagogastric junction 10 . We have identified 12 reports of hemorrhagic downhill esophageal varices related to thyroid tumors so far, but no cases of death due to hemorrhage 2,4,[10][11][12][13][14][15][16][17][18][19] . 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.…”

Section: Discussionmentioning

confidence: 99%

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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