CTICasesMassive Paraesophageal Varices in End-Stage Liver Disease
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Imaging findings
Chest radiograph in 2010 showed a basal and medial right thoracic opacity, initially considered a hiatal hernia. By 2014, the opacity was larger, accompanied by a right-sided pleural effusion. MRI confirmed massive paraesophageal varices, showing large flow voids on haste images. The patient also has an enlarged spleen and end-stage liver disease.
Key takeaways
Massive paraesophageal varices in end-stage liver disease can manifest as a large, often misdiagnosed, retrocardiac or mediastinal opacity on chest radiographs, mimicking hiatal hernia or other masses. MRI, particularly with non-contrast flow-sensitive sequences, can definitively characterize these vascular structures by demonstrating flow voids. Clinical context of liver disease is crucial for accurate interpretation.
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