title: Downhill esophageal varices: a prevalent complication of superior vena cava obstruction from benign and malignant causes.
abstract: OBJECTIVE
  Downhill esophageal varices (DEV) usually develop secondary to superior vena cava (SVC) obstruction. Downhill esophageal varices have been less well characterized compared to uphill varices. The aim of the study was to characterize the anatomy and etiology of DEV by contrast-enhanced computed tomography.
  
  
  METHODS
  Patients with SVC obstruction were included in the study. Downhill esophageal varices were defined as discrete esophageal submucosal or mucosal vessels. Ten random computed tomographic scans were assessed as controls.
  
  
  RESULTS
  Downhill esophageal varices were seen in 11 of 36 patients. Three types of varices were observed. Between 1 and 6 varices were seen in each patient with a diameter of 1 to 5 mm.
  
  
  CONCLUSIONS
  Downhill esophageal varices can be seen in 30% of patients with SVC obstruction. They have several patterns and are mostly systemic-to-systemic collaterals. The most common etiology associated with DEV is renal failure. Downhill esophageal varices are of small caliber, this may in part account for less frequent bleeding compared to uphill varices.
authors.affiliation: From the *Thoracic and Abdominal Imaging Sections, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL; and †Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Yoel
authors.initials: Y
authors.lastname: Siegel
authors.forename: Erica
authors.initials: E
authors.lastname: Schallert
authors.forename: Russ
authors.initials: R
authors.lastname: Kuker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013479:Superior Vena Cava Syndrome / Q000150:complications* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D003287:Contrast Media