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. 2014 Mar;4(1):63-5.
doi: 10.1016/j.jceh.2013.10.003. Epub 2014 Jan 2.

Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation

Yogesh P Harwani  1 , Ajit Kumar  1 , Akash Chaudhary  1 , Manoj Kumar  1 , Padmavathi R Choudeswari  1 , Vishnu V Kankanala  1 , Nayana Joshi  1 , Chintan Kansagra  1 , Sandip Shah  1 , Abhisheka Tripathi  1
Affiliations

Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation

Yogesh P Harwani et al. J Clin Exp Hepatol. 2014 Mar.

Abstract

Hemorrhage from downhill varices is a rare manifestation. The etiology of downhill varices is due to superior vena cava obstruction while uphill varices are secondary to portal hypertension. We report a rare case of 55-year-old female with bleeding downhill varices not associated with obstruction or compression of superior vena cava, but was due to severe pulmonary artery hypertension secondary to chronic rheumatic heart disease.

Keywords: ALT, alanine transferase; AST, aspartate aminotransferase; CRHD, chronic rheumatic heart disease; LA, left atrium; LV, left ventricular; MDCT, multidetector computed tomography; PAH, pulmonary artery hypertension; RA, right atrium; RCS, red colour signs; RVH, right ventricular hypertrophy; SVC, superior vena cava; TR, severe tricuspid regurgitation; downhill varices; pulmonary artery hypertension; rheumatic heart disease; uphill varices.

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Figures

Figure 1
Figure 1
Chest X-ray showing cardiomegaly.
Figure 2
Figure 2
Downhill varices with red colour signs (RCS) in upper esophagus.
Figure 3
Figure 3
Uphill varices in lower esophagus.
Figure 4
Figure 4
Multidetector computed tomography (MDCT) showing cardiomegaly, no superior vena cava (SVC) obstruction and dilated pulmonary artery.
See this image and copyright information in PMC

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