Computed radiography of the chest in patients with paraesophageal varices: diagnostic accuracy and characteristic findings.

OBJECTIVE: The purpose of our study was to determine the diagnostic accuracy of computed radiography of the chest in the detection of paraesophageal varices and to describe the characteristic radiographic findings. SUBJECTS AND METHODS: From June 1995 through May 1997, in 100 consecutive patients, portal hypertension was diagnosed through both clinical and radiologic evidence. Computed radiographs of the chest and hepatic helical CT scans of these 100 patients with portal hypertension and 20 control subjects were analyzed by two chest radiologists and one abdominal radiologist, who were not aware of the results of the other study.
RESULTS: On CT, paraesophageal varices were seen in 38 (38%) of 100 patients with portal hypertension. Overall, the sensitivity, specificity, and accuracy of chest computed radiography in the detection of paraesophageal varices were 53% (20/38), 90% (74/82), and 78% (94/120), respectively. In the patients with paraesophageal varices, splenomegaly (29/38, 76%), lateral displacement or obliteration of the inferior portion of the azygoesophageal interface (18/38, 47%), obliteration or nodularity of the inferior portion of the descending thoracic aorta interface (9/38, 24%), lateral displacement of the right inferior paraspinal interface (6/38, 16%), lateral displacement of the left inferior paraspinal interface (4/38, 11%), and varices in the left inferior pulmonary ligament (1/38, 3%) were seen on chest computed radiographs. Paraesophageal varices smaller than the diameter of the descending thoracic aorta (usually <2.5 cm) were not detected.
CONCLUSION: Although chest computed radiography is only moderately sensitive for paraesophageal varices, the findings are characteristic when well developed, with a limited differential diagnosis. Splenomegaly, whether detected clinically or radiographically, eliminates most other diagnostic possibilities.