Atypical Presentation of Downhill Esophageal Varices: A Diagnostic Enigma
Year: 2026
Type: article
Study design: Case Report
Abstract: Downhill esophageal varices (DEV) are rare vascular abnormalities of the proximal esophagus, commonly caused by superior vena cava obstruction. We report a 75-year-old man who presented with intermittent dysphagia and globus sensation, in whom endoscopy demonstrated large proximal esophageal varices. Extensive evaluation excluded portal hypertension and cross-sectional imaging, and venography showed a patent superior vena cava and inferior vena cava but demonstrated right internal jugular vein occlusion with possible azygos system compression. These findings were considered remote and insufficient to explain the extensive proximal varices, which were ultimately classified as idiopathic DEV. This atypical presentation underscores the diagnostic challenges of DEV and the need for heightened clinical awareness of this rare entity.
Source: ACG Case Reports Journal
Authors: Karim Al Annan, Hira Khan, Marianna Scranton
Institution: UConn Health
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7130653274