title: 'Downhill' esophageal varices. A rare cause of upper gastrointestinal bleeding.
abstract: The submucosal venous network of the esophagus is part of the collateral system that develops following superior vena caval obstruction from any cause. The direction of flow in these thin-walled, valveless veins is "downhill," towards the azygous vein or to the inferior vena cava. Bleeding from upper esophageal varices is extremely rare. This case report describes a patient with massive bleeding from upper esophageal varices secondary to superior vena caval obstruction by a malignant thyroid tumor. Total thyroidectomy relieved the obstruction, with cessation of hemorrhage and subsequent disappearance of the varices.
mesh_terms: D000368:Aged; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D011859:Radiography; D013964:Thyroid Neoplasms / Q000150:complications* / Q000601:surgery; D013965:Thyroidectomy; D014652:Vascular Diseases / Q000150:complications / Q000209:etiology; D014683:Vena Cava, Superior