1987 Volume 29 Issue 2 Pages 296-301_1
A 57-year-old woman with Behcet's disease who had recurrent episodes of oral ap superior vena caval thrombosis re-admited to our hospital because of recurrent fever and right hypo-chondralgia. Laboratory data including ICG retention rate, platelet count, TTT, ZTT, γ-globulin were normal but serum alkaline-phosphatase activity was slightly elevated (Table 1). Cholecyst-hepatolithiasis was found by abdominal echography and CT, and seemed to cause her symptoms. Esophagogram (Figure 4) and endoscopic examination (Figure 5-7) revealed varices localized in upper-two-thirds of the esophagus (so called "downhii varices"). Thrombosis of distal inferior vena cava was also shown by abdominal CT and RI-angiography (Figure 3). Nine cases of downhill varices associated with thrombosis of the superior vena cava have been reported in the literatures (Table 2), including 4 cases of vasculo-Behcet's disease. Such high incidence in Behcet's disease must be paid attention. Thus, the occurrence of it should be taken into account in Behcet's disease with superior vena caval thrombosis, especially in Japan where high prevalent rate is found. There were reported 3 cases complicating thrombosis of the inferior vena caval system, indicating advancing process of downhill varices. Therefore, anti-coagulant therapy should be given carefully to patients with downhill esophageal varices associated with superior vena caval thrombosis.
