An unusual cause of hematemesis: Goiter

Figure 1 Endoscopic view demonstrating downhill varices (A) and almost complete disappearance of the downhill varices (B) before and 12 mo after thyroidectomy of the right lobe.

Figure 2 3D reconstruction of CT angiography with view at the dorsal wall of the trachea (T) demonstrating a venous plexus of downhill varices (V) on the wall between the esophagus and trachea connected with a thyroid vein at the goiter (G) of the right thyroid lobe; *, out of plane, cut off level thick slice.

Figure 3 CT angiography demonstrating downhill varices one day after hemorrhage (A) and disappearance of the downhill varices 12 mo after thyroidectomy of the right lobe (B). * indicates varices around the esophagus; T, trachea.

Figure 4 Venous blood flow of the downhill varices in relation to goiter. 1: internal jugular vein; 2: dilated right internal jugular vein; 3: goiter with compression of the right internal jugular vein; 4: thyroid plexus draining into the esophagus varices; 5: inferior thyroid vein; 6: brachiocephalic vein; 7: varices around the esophagus; 8: azygos vein; 9: superior vena cava; Block: Occlusion of the inferior thyroid vein, possibly as a result of previous surgery or recurrent goiter.