Downhill Varices and Apical Lung Cancer Without Superior Vena Cava Syndrome.

A 75-year-old woman with hypertension, dyslipidemia, thalassemia trait, osteoarthritis of the knees, and hyperthyroidism presented with bloating, abdominal discomfort, and change in stool caliber underwent an esophagogastroduodenoscopy. The esophagogastroduodenoscopy revealed varices at the middle of esophagus, which were diagnosed to be downhill esophageal varices (DEVs). DEVs occur mainly from the superior vena cava (SVC) obstruction; however, in the absence of obstruction, angiogenesis and thrombosis could be the etiology. In our patient, computed tomography showed a pulmonary nodule located at periphery of the right upper lung without SVC contact nor obstruction. The nodule was later proven to be an adenocarcinoma. Thus, our patient showed the possibility that adenocarcinoma of the lung might associated with the DEV through a mechanism other than SVC obstruction. Recognition and differentiation of DEV from other benign venous blebs of the esophagus are important, and once detected, further investigation with computed tomography of the chest is recommended.

Hematemesis, a Rare Presentation for Downhill Esophageal Varices.

Downhill esophageal varices (DEV) are a rare form of esophageal varices associated with superior vena cava obstruction. Obstruction leads to retrograde blood flow through collateral venous channels, including the esophageal venous plexus, to redirect blood flow to the right atrium via the inferior vena cava. This leads to the formation of DEV. It is a rare phenomenon to have gastrointestinal bleeding, especially hematemesis, on a patient's first presentation with this disease process. We describe such a case here involving a patient with DEV secondary to metastatic renal cell carcinoma presenting with hematemesis.

Recurrent Hematemesis From Downhill Esophageal Varices: A Therapeutic Challenge for Gastroenterologists.

Downhill or upper esophageal varices have an etiology that differs from that of the "uphill" varices secondary to portal hypertension. Approximately 0.1% of all cases of variceal hemorrhage are due to downhill varices. The underlying etiology is obstruction of the superior vena cava (SVC) which results in the shunting of blood from the systemic circulation into the esophageal plexus, predominantly the upper two-thirds. The management should be directed to relieve the vascular obstruction. One of the causes of SVC obstruction leading to downhill variceal bleeding is dialysis catheter-associated SVC stenosis. We report the case of a 34-year-old male with hematemesis associated with downhill varices due to chronic SVC obstruction because of a central venous catheter.

Várices esofágicas superiores ( Downhill varices ). Presentación de casos y revisión de la literatura / Upper esophageal varices (Downhill varices): Case presentation and literature review

Resumen Se describen 21 casos con hallazgo incidental de várices esofágicas superiores (Downhill varices) en endoscopia de las vías digestivas altas. Además, se detallan algunos datos relevantes de la historia clínica y de los hallazgos endoscópicos. La relación hombres/mujeres fue 1:1 y la edad promedio fue de 67,9 años. La comorbilidad más frecuente fue la enfermedad pulmonar obstructiva crónica (EPOC), seguida de las neumoconiosis, la obesidad y el síndrome de apnea-hipopnea, todas con hipertensión pulmonar (HTP) asociada. Las tres últimas causas no han sido descritas previamente en la literatura sobre várices esofágicas superiores. Ningún paciente tenía antecedente de hemorragia variceal.

Abstract We describe 21 cases with incidental endoscopic findings of upper esophageal varices (downhill varices) and relevant data from patients' clinical histories and endoscopic findings. The male/female ratio was 1:1 and patients' average age was 67.9 years. The most frequent comorbidity was chronic obstructive pulmonary disease, followed by pneumoconiosis, obesity and apnea-hypopnea syndrome. All comorbidities had associated pulmonary hypertension. The last three causes have not been previously described in the literature on upper esophageal varices. None of the patients had histories of variceal hemorrhaging.

Superior Vena Cava Obstruction: A Rare Cause of Recurrent Esophageal Variceal Bleeding.

"Downhill" esophageal varices are formed in upper two-thirds of the esophagus as a consequence of a superior vena cava obstruction. We present a case of 55-year-old African-American female with a medical history of multiple comorbidities, including end-stage renal disease, who presented with an upper gastrointestinal bleed and was found to have distended neck veins on physical examination. She gave a history of the insertion of an intravenous central line in her neck area for hemodialysis purposes about six years previously. An endoscopy showed the presence of esophageal varices and computed tomography (CT) of the abdomen showed the presence of a superior vena cava (SVC) obstruction. The patient was managed supportively. This case represents a rare cause of acute upper gastrointestinal bleeding in an individual with a central line for dialysis leading to SVC thrombosis.

Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation.

Hemorrhage from downhill varices is a rare manifestation. The etiology of downhill varices is due to superior vena cava obstruction while uphill varices are secondary to portal hypertension. We report a rare case of 55-year-old female with bleeding downhill varices not associated with obstruction or compression of superior vena cava, but was due to severe pulmonary artery hypertension secondary to chronic rheumatic heart disease.