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Kitkarncharoensin N, Catithammanit S, Chavanachinda N, Phruttinarakorn B, Cherntanomwong P, Kitiyakara T. Downhill Varices and Apical Lung Cancer Without Superior Vena Cava Syndrome. ACG Case Rep J 2024; 11:e01236. [PMID: 38162006 PMCID: PMC10754591 DOI: 10.14309/crj.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
| | - Sarin Catithammanit
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Bantita Phruttinarakorn
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Cherntanomwong
- Cardiothoracic Surgical Unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taya Kitiyakara
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ali H, Pamarthy R, Bolick NL, Ali E, Paleti S, Kapuria D. Downhill esophageal varices: a systematic review of the case reports. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Hassam Ali
- 1Department of Internal Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Rahul Pamarthy
- 1Department of Internal Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Nicole Leigh Bolick
- 2Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Eslam Ali
- 3Department of Gastroenterology, East Carolina University, Greenville, NC 27834, USA
| | - Swathi Paleti
- 4Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Devika Kapuria
- 5Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO 63130, USA
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Burgueño Gómez B, Lindo Ricce M, Mora Cuadrado N, González de Frutos C. Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:412-413. [PMID: 32338028 DOI: 10.17235/reed.2020.6376/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tuberous sclerosis complex (TSC) is a rare disease which is characterized by widespread of a variety of benign tumors in multiple organs. Renal angiomyolipomas (AMLs) are the primary cause of morbidity in TSC due to anemia, renal failure or spontaneous bleeding. In contrast, the hepatic involvement is unusual and it is infrequently described in literature.
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Chakinala RC, Kumar A, Barsa JE, Mehta D, Haq KF, Solanki S, Tewari V, Aronow WS. Downhill esophageal varices: a therapeutic dilemma. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:463. [PMID: 30603651 DOI: 10.21037/atm.2018.11.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal varices can cause life-threatening complications and are most often a sequela of liver disease. Although a rare cause of gastrointestinal bleeding, downhill variceal bleeding secondary to superior vena cava (SVC) obstruction should be considered in the differential diagnosis for patients with upper gastrointestinal hemorrhage. We discuss two such cases of downhill esophageal varices presenting with hematemesis in patients with end stage renal disease and no history of cirrhosis. These varices were thought to be secondary to SVC occlusion caused by complications from previous dialysis catheters. However, their difficult anatomy posed a significant challenge to the therapeutic interventions.
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Affiliation(s)
- Raja Chandra Chakinala
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Anila Kumar
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Jonathan E Barsa
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Dhruv Mehta
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Khwaja F Haq
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Shantanu Solanki
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Virendra Tewari
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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