Imaging description

Esophageal varices cause nonspecific thickening of the esophageal wall by CT without intravenous contrast material. After intravenous contrast material administration, varices enhance unless images are obtained very soon after contrast injection. As esophageal varices enlarge they become tortuous, tubular, and longitudinal (serpiginous) masses within the wall that cause lobulation of the esophageal lumen (Figures 40.1 and 40.2). They may be more prominent on the right side due to the presence of the descending aorta on the left. Esophageal uphill varices are often associated with CT findings of hepatic cirrhosis, splenomegaly, and gastric varices in the upper abdomen. Large varices have a higher risk of variceal hemorrhage. A conservative criterion for a large varix is a short-axis diameter of 3 mm or greater [1]. Paraesophageal varices are often associated with esophageal varices (Figure 40.3).