Oesophageal varices in a case of compressive goiter

Abstract

Downhill oesophageal varices are venous submucosal dilatations developing in the upper oesophagus, draining upper body venous flow "downwards" and usually bypassing superior vena cava obstruction. Extrinsic compression from a thyroid goiter is a rare cause with only 18 cases reported in the literature. We report the case of an 84 year old woman with a long history of multinodular goiter admitted for the exploration of severe iron-deficiency anemia. She had no history of hematemesis or melena. The endoscopic exam found grade II upper oesophageal varices with no sign of active bleeding, as well as a non hemorrhagic gastric ulcer. No other obvious explanation for anemia could be found. Goiter investigation included a cervical and thoracic CT scan which evidenced a voluminous thyroid goiter with massive endothoracic extension, causing oesophageal compression. The optimal treatment was considered to be radioiodine therapy followed by surgery. Downhill oesophageal varices are a rare clinical entity seen in patients with goiter. We propose a clinical observation of this pathology in a patient explored for chronic anemia.