Review

Review

Esophageal varices Uphill  cause bleeding  from portal HTN (reversal of flow “uphill” from portal vein > left gastric > periesophageal venous plexus > azygous and hemiazygous collaterals > SVC)  collapsing, long serpentine filling defects in the distal esophagus on UGI study; differentiate from varicoid carcinoma Downhill  asymptomatic  obstruction of SVC > collateral enlargement in supreme intercostal, bronchial and inferior thyroid veins  tubular thickened folds in upper thoracic esophgus  look for reason for SVC syndrome (bronchogenic carcinoma, lymphoma, or fibrosing mediastinitis)

History: 50 year old male with chronic lower back pain.

Radiographic differential diagnosis includes: 

- simple bone cyst - central location (unlike ABC) - absence of expansion - lack of cortical discontinuity - giant cell tumor of bone - occurs in patients over age 20 - lack of expansion - begin in epiphysis with extension into metaphysis - more likely to be centrally located - telangiectatic osteosarcoma - difficult to distinguish radiographically from an aggressive ABC - angiosarcoma. - osteoblastoma - may have a “soap bubble” expansile appearance - no fluid level on CT/MR

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