Vallecular Varix: A Perplexing Cause of Oral Cavity Bleeding

Abstract

Often discovered only after an extensive work up for hemoptysis and hematemesis, vallecular varices are a rare cause of oral bleeding that increase patient morbidity due to delay of diagnosis. We describe an 89-year-old male who presented with a week of intermittent oral blood production. A vallecular varix was identified on fiberoptic laryngoscopy after studies for hematemesis and hemoptysis had been performed, including negative esophagogastroduodenoscopy and bronchoscopy. Awareness of this pathology and key points in the patient history can direct the clinician toward the correct diagnosis, expediting treatment and limiting invasive diagnostic procedures for pulmonary or gastric etiologies of bleeding.

Figure 1

Vallecular varix. Pedunculated varix in the left vallecula with clot in center. A) Tongue base. B) Lateral pharyngeal wall. C) Epiglottis.

Figure 2

Extrication of varix. Extrication of varix at the base with Jako scissors after yttrium aluminum garnet laser cauterization. A) Tongue base. B) Lateral pharyngeal wall. C) Epiglottis.