Читать книгу The Esophagus - Группа авторов - Страница 198

Uphill esophageal varices usually develop as a result of portal hypertension or other causes of portal venous obstruction. Varices appear on barium studies as serpiginous or tortuous longitudinal filling defects in the distal half of the thoracic esophagus [139] (Figure 6.77). They are best seen on mucosal relief views of the collapsed or partially collapsed esophagus using a high‐density barium suspension to increase mucosal adherence [139]. The differential diagnosis for varices includes submucosally infiltrating esophageal carcinomas (so‐called varicoid carcinomas) and esophagitis with thickened folds caused by submucosal edema and inflammation.

Esophageal varices are characterized on CT by a thickened, lobulated esophageal wall containing tubular structures that enhance markedly after intravenous administration of contrast material [139]. Additional varices may be seen elsewhere in the abdomen at other sites of communication between the portal and systemic venous circulations. Angiography of the celiac or superior mesenteric arteries can be used to confirm the presence of varices in and around the distal esophagus. However, the need for portal venography for presurgical planning of portosystemic shunts has decreased with the widespread use of transjugular intrahepatic portosystemic shunting procedures.

Figure 6.77 Esophageal varices. Single‐contrast view shows multiple large serpiginous defects in the lower third of the esophagus in a patient with portal hypertension and uphill esophageal varices.