Tracheal Varix in Portal Hypertension
Monash Medical Centre, Clayton, Melbourne, Victoria, Australia.Journal of thoracic imaging (Impact Factor: 1.74). 02/2011; 27(1):W10-2. DOI: 10.1097/RTI.0b013e318205a4a5
A 56-year-old female nonsmoker presented with episodic hemoptysis, without any other associated respiratory symptoms. Her medical history was notable for polycythemia rubra vera with portal vein thrombosis, which was treated with warfarin, but was complicated by portal hypertension. Esophageal varices were controlled by endoscopic band ligation. Chest radiograph and 64-slice computed tomography scanning failed to identify a culprit lesion. Bronchoscopy identified a vascular structure in the proximal trachea. A contrast-enhanced 320-multidetector row computed tomography scan of the neck showed a tortuous vascular channel in the trachea, which changed in appearance over time, consistent with a tracheal varix. The patient was changed to aspirin therapy and was evaluated by a cardiothoracic surgeon. A conservative approach was adopted, and the patient has had no recurrence of symptoms.
Article: Haematemesis, haemoptysis, or both?
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ABSTRACT: Tracheal varices and bronchial varices are infrequently reported in adults as a complication of an underlying vascular obstruction, including portal hypertension, pulmonary arterial hypertension, or pulmonary venous hypertension. Tracheal varices and bronchial varices have been reported in adults with failing Fontan physiology, but this occurrence is rare in children. We report the unusual presentation of tracheal-bronchial varices due to veno-venous collaterals in an adolescent patient with Glenn physiology for double-inlet left ventricle and portal hypertension secondary to cardiac cirrhosis. We document complete resolution of these varices after heart and liver transplantation.
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ABSTRACT: Variceal bleeding remains a life-threatening condition with a 6-week mortality rate of ∼20%. Prevention of variceal bleeding can be achieved using nonselective β-blockers (NSBBs) or endoscopic band ligation (EBL), with NSBBs as the first-line treatment. EBL should be reserved for cases of intolerance or contraindications to NSBBs. Although NSBBs cannot be used to prevent varices, if the hepatic venous pressure gradient (HVPG) is ≤10 mmHg, prognosis is excellent. Survival after acute variceal bleeding has improved over the past three decades, but patients with Child-Pugh grade C cirrhosis remain at greatest risk. Vasoactive drugs combined with endoscopic therapy and antibiotics are the best therapeutic strategy for these patients. Transjugular intrahepatic portosystemic shunts (TIPS) should be used in patients with uncontrolled bleeding or those who are likely to have difficult-to-control bleeding. Rebleeding from varices occurs in ∼60% of patients 1-2 years after the initial bleeding episode, with a mortality rate of 30%. Secondary prophylaxis should start at day 6 after initial bleeding using a combination of NSBBs and EBL. TIPS with polytetrafluoroethylene-covered stents are the preferred option in patients who fail combined treatment with NSBBs and EBL. Despite the improvement in patient survival, further studies are needed to direct the management of patients with gastro-oesophageal varices and variceal bleeding.
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