CTICasesEsophageal Varix Draining to a Pulmonary Vein in Fibromuscular Dysplasia
Imaging findings
A patient with known fibromuscular dysplasia shows classic beading of the renal arteries and has esophageal varices. On abdominal CT a vessel was seen heading cephalad into the chest, and a chest CT with good bilateral contrast opacification shows this vessel connecting to a branch of the right inferior pulmonary vein. It fills in the early phase from the pulmonary vein while the other varices do not fill, indicating flow from north to south rather than an arterial feeder.
Key takeaways
An esophageal varix can communicate with the inferior pulmonary vein, and characterizing the vessel as a venous varix rather than an artery is important: its filling in the same phase as the pulmonary vein and the absence of shunt-sized flow argue for retrograde (cephalad-to-caudad) venous flow rather than an arterial shunt. Recognizing this venous collateral pathway avoids misinterpreting it as an arteriovenous shunt.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Constrictive Bronchiolitis after Stem Cell TransplantInflammatory
- Pulmonary Embolism on a Low-Contrast Non-CTPA StudyVascular
- Intravascular Pulmonary Metastases with InfarctionNeoplastic
- Occult Lower Lobe Collapse from Endobronchial CarcinoidNeoplastic
- Chronic Thromboembolic Disease with Clot Propagation Mimicking SarcomaVascular
- Granulomatous-Lymphocytic Interstitial Lung Disease in CVIDILD
- Pulmonary AVMs from Hepatic Venous Exclusion in HeterotaxyVascular
- Pediatric Takayasu Arteritis with Abdominal Aortic PseudoaneurysmAutoimmune
See all cases from October 17, 2020 →