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Case Reports
. 2023 Dec 28;11(1):e01236.
doi: 10.14309/crj.0000000000001236. eCollection 2024 Jan.

Downhill Varices and Apical Lung Cancer Without Superior Vena Cava Syndrome

Nicharee Kitkarncharoensin  1 , Sarin Catithammanit  1 , Niravit Chavanachinda  1 , Bantita Phruttinarakorn  2 , Piya Cherntanomwong  3 , Taya Kitiyakara  4
Affiliations
Case Reports

Downhill Varices and Apical Lung Cancer Without Superior Vena Cava Syndrome

Nicharee Kitkarncharoensin et al. ACG Case Rep J. .

Abstract

A 75-year-old woman with hypertension, dyslipidemia, thalassemia trait, osteoarthritis of the knees, and hyperthyroidism presented with bloating, abdominal discomfort, and change in stool caliber underwent an esophagogastroduodenoscopy. The esophagogastroduodenoscopy revealed varices at the middle of esophagus, which were diagnosed to be downhill esophageal varices (DEVs). DEVs occur mainly from the superior vena cava (SVC) obstruction; however, in the absence of obstruction, angiogenesis and thrombosis could be the etiology. In our patient, computed tomography showed a pulmonary nodule located at periphery of the right upper lung without SVC contact nor obstruction. The nodule was later proven to be an adenocarcinoma. Thus, our patient showed the possibility that adenocarcinoma of the lung might associated with the DEV through a mechanism other than SVC obstruction. Recognition and differentiation of DEV from other benign venous blebs of the esophagus are important, and once detected, further investigation with computed tomography of the chest is recommended.

Keywords: SVC obstruction; SVC syndrome; downhill varices; esophageal varices; lung cancer; varix.

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Figures

Figure 1.
Figure 1.
Downhill esophageal varices seen in the patient. Two F2 varices and 1 F1 varix were seen between 30 and 35 cm from the incisors.
Figure 2.
Figure 2.
Chest x-ray posteroanterior upright showing a reticular-ground glass at right upper lung zone, which was barely detectable.
Figure 3.
Figure 3.
CT of the chest and mediastinum axial plane showing a 2.7-cm nodule at periphery of the right upper lung. CT, computed tomography.
Figure 4.
Figure 4.
CT of the chest and mediastinum coronal plane showing a 2.7-cm nodule at periphery of the right upper lung. CT, computed tomography.
Figure 5.
Figure 5.
The histopathological specimen showing adenocarcinoma with acinar pattern.
Figure 6.
Figure 6.
The histopathological specimen showing a lepidic adenocarcinoma, with pulmonary vein but no thrombosis.
See this image and copyright information in PMC

References

    1. Israelski M, Simchowitz H. 1. Roentgendiagnostic der esophagus varizen. Laryngol Rhinol Otol. 1932;22:208–18.
    1. Ali H, Pamarthy R, Bolick NL, Ali E, Paleti S, Kapuria D. Downhill esophageal varices: A systematic review of the case reports. Explor Med. 2022;3(4):317–30.
    1. Loudin M, Anderson S, Schlansky B. Bleeding ‘downhill’ esophageal varices associated with benign superior vena cava obstruction: Case report and literature review. BMC Gastroenterol. 2016;16(1):134. - PMC - PubMed
    1. Savoy AD, Wolfsen HC, Paz-Fumagalli R, Raimondo M. Endoscopic therapy for bleeding proximal esophageal varices: A case report. Gastrointest Endosc. 2004;59(2):310–3. - PubMed
    1. Tanaka H, Nakahara K, Goto K. Two cases of downhill esophageal varices associated with superior vena cava syndrome due to lung cancer [in Japanese]. Nihon Kyobu Shikkan Gakkai Zasshi. 1991;29(11):1484–8. - PubMed

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