Solitary esophageal varix simulating a neoplasm.

A 57-year-old woman was referred to the University of Michigan Hospital in July 1984 for evaluation of iron deficiency anemia. She was transfused with five units of blood and then underwent complete evaluation of her gastrointestinal tract. During double contrast examination of her upper gastrointestinal tract a 2.0 x 1.3 cm lobulated well demarcated polypoid lesion was found in the mid esophagus. This lesion was unaffected by esophageal distension (Figure 1). It was felt to be a benign lesion such as a fibrovascular polyp or a lipoma, however, malignancy could not be completely excluded. The remainder of the upper gastrointestinal tract and small bowel follow through was normal except for a small hiatal hernia. An air contrast barium enema was unremarkable. Endoscopic examination of the esophagus revealed a sausage shaped lobulated 2.1 x 1 cm firm submucosal mass in the mid esophagus with normal overlying mucosa. It had the bluish tinge of an ectatic venous structure. The diagnosis of a thrombosed esophageal varix was made. To completely exclude the possibility of a neoplasm a mucosal biopsy was performed which was normal at histopathologic examination. Colonscopy revealed large internal hemorrhoids and no other abnormalities. A chest CT examination did not reveal any mediastinal abnormalities. The esophageal varix was not seen. There was no evidence of portal hypertension or liver disease.