title: "Downhill" esophageal varices and occlusion of superior and inferior vena cavas due to a systemic venulitis.
abstract: A patient with a 10-year history of episodes of venous thrombosis, a high ESR, an elevated plasma polyclonal 1gG concentration, and bleeding from esophageal varices had obstruction of both superior and inferior vena cavas with "downhill" esophageal varices and a normal portal vein with normal portal pressure. Extensive investigations revealed no predisposing factor for the venous thromboses, but the patient made a good clinical response to steroids and dapsone, with no further episodes of bleeding nor evidence of major venous thrombosis. The causes and outcome of "downhill" varices are discussed.
mesh_terms: D000328:Adult; D001799:Blood Sedimentation; D003622:Dapsone / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006801:Humans; D011239:Prednisolone / Q000627:therapeutic use; D013479:Superior Vena Cava Syndrome / Q000473:pathology*; D013927:Thrombosis / Q000150:complications; D014652:Vascular Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014682:Vena Cava, Inferior / Q000473:pathology*
chemical_list: D003622:Dapsone; D011239:Prednisolone