2020 Volume 62 Issue 12 Pages 3049-3056
A 59-year-old man with a history of cardiac conduction disease underwent permanent pacemaker implantation. During his follow-up, gastrointestinal endoscopy performed as a medical checkup incidentally revealed varices from the upper to middle esophagus (F1, Cw, RC1(CRS)). The contrast-enhanced computed tomographic (CT) images demonstrated stenosis of the superior vena cava (SVC), a 7cm thrombus in the dilated right internal jugular vein and dilation of the azygous vein. He did not have portal hypertension, and the clinical diagnosis of downhill esophageal varices (DEV) due to SVC syndrome was made. To improve blood flow, he started anticoagulant treatment with rivaroxaban (15mg/day). Over five months of observation, the thrombus markedly decreased in size on CT imaging. The varices also improved one year after starting anticoagulant treatment. DEV is a rare form of esophageal varices induced by various causes, but there is no standard established treatment. We present a case of DEV due to SVC syndrome that was successfully treated with anticoagulant medicine.
