Читать книгу The Esophagus - Группа авторов - Страница 199

One of the most common causes of downhill varices is bronchogenic carcinoma with mediastinal metastases and superior vena cava obstruction [139]. Additional causes include other primary or metastatic tumors involving the mediastinum, mediastinal irradiation, sclerosing mediastinitis, substernal goiter, and central catheter‐related thrombosis of the superior vena cava. Most patients with downhill varices present clinically with the superior vena cava syndrome.

Downhill varices typically appear as serpiginous longitudinal filling defects, which, unlike uphill esophageal varices, are confined to the upper or mid esophagus [139]. Venography may be performed to confirm the presence of superior vena cava obstruction, and chest radiographs or CT may be performed to determine the underlying cause.