Esophageal varices occur usually in response to portal hypertension. Damaged liver parenchyma, usually from cirrhosis, causes increased resistance to portal blood through the liver, and thus collaterals form to bypass the liver. Although collaterals can form anywhere within the GI tract, these most commonly form in the lower esophagus (“uphill varices”). In addition, esophageal varices may develop in patients with superior vena cava thrombosis or obstruction (“downhill varices,” which appear more proximally).
CT shows tubular structures surrounding the esophagus that enhance intensely with IV contrast.
One third of patients will bleed from their varices, and half of these patients will succomb from them. Treatment in the acute setting includes Blakemore tube (balloon), endoscopic sclerotherapy and banding, and phamacotherapy. Interventional radiology can embolize the portal vein. In addition, a transjugular intrahepatic portosystemic shunt (TIPS) may be placed by an interventional radiologist between the hepatic and portal veins to decrease resistance to flow.