"Downhill" varices; a cause of upper gastrointestinal hemorrhage.

Intrathoracic goiter remains an interesting diagnostic and surgical problem. A case of a patient with intrathoracic goiter causing a superior vena cava syndrome which resulted in "downhill" esophageal varices and bleeding is presented. This is the 36th case of reported "downhill" esophageal varices and the ninth to cause massive upper gastrointestinal hemorrhage. Intrathoracic goiter is a rare benign cause of "downhill" esophageal varices and bleeding, which can be completely cured by thyroidectomy. It is advisable to consider the addition of a vertical sternotomy in such instances for easier and safer control of the vast collateral venous drainage encountered during removal of the mediastinal component of the tumor.