[Two cases of downhill esophageal varices associated with superior vena cava syndrome due to lung cancer]

Abstract

Two cases of downhill esophageal varices associated with superior vena cava syndrome due to lung cancer are reported. Case 1 was a 68-year-old male with swelling of the upper right half his body. Chest X-ray film showed a mass shadow in the upper right lung field. Small cell lung cancer completely obstructed the superior vena cava. Esophagoscopy showed four striated downhill esophageal varices (F1, CB, RC(-]. After treatment with concurrent chemoradiotherapy, he had a partial response and the varices disappeared. Case 2 was a 55-year-old male with productive cough. The superior vena cava was narrowed by squamous cell lung cancer, with good collateral pathways. Three striated downhill varices (F1, CW, RC(-] were present. Concurrent chemoradiotherapy resulted in partial response, but the number of striated varices increased to four and CB, and extended downward. Left jugular venography revealed collateral veins to the esophagus, although bilateral brachial venography revealed no collaterals. Dynamic CT with bolus injection of contrast medium via the left jugular vein demonstrated esophageal varices. There are few reports on the blood flow of downhill esophageal varices.