Detection of paraesophageal varices by plain films

Paraesophageal Varices Presenting as a Retrocardiac Mediastinal Mass

This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiograph. Schistosoma mansoni, the probable etiology in this case, causes periportal fibrosis and is the most common explanation for portal hypertension worldwide. Modern imaging techniques were most helpful in the diagnostic work-up, ultrasonography revealing pathognomonic hyperechoic periportal bands, and CT and MR imaging showing the extent of collaterals.

Benign Anatomical Mistakes: Inferior Pulmonary Ligament

The term inferior pulmonary ligament needs to be revised. There is no superior component to oppose the inferior. By all means the pulmonary ligament is not a ligament, and the term ligament should be reserved for regularly oriented thick connective tissue bundles between bones. The term triangular ligament describes its shape but not its topography. For most surgeons the broad ligament refers, rather, to the ligament of the uterus. Embryologically pulmonary ligament is a “meson” i.e., a remnant of the developmental pathway—the pleural fold in this case—and taking this into consideration the most convenient term seems to be mesopneumonium. Its upper part is related to the hilar area, and its lower free border is what we call pulmonary ligament. We suggest the term mesopneumonium to describe the whole “meson” from the mediastinum to the hilum, which corresponds better to topography, embryology, and function.

Azygoesophageal recess

Knowledge of the normal radiologic appearance and manifestations of disease in the azygoesophageal recess can facilitate the detection and diagnosis of intrathoracic disease. The azygoesophageal recess is located lateral or posterior to the esophagus and anterior to the spine. It extends from the anterior turn of the azygous vein to the aortic hiatus. The configuration of the azygoesophageal recess is normally a smooth arc convex to the left. Because the right lung extends into the recess, pathology in this region can often be detected radiographically and typically manifests as increased opacity and/or as a contour abnormality. In adults, convexity directed to the right and immediately below the level of the azygous vein on a frontal radiograph is abnormal and requires further evaluation.

Thoracic manifestations associated with advanced liver disease

Advanced liver disease and portal hypertension may produce various intrathoracic complications that involve the pleural space, lung parenchyma, and pulmonary circulation. Dyspnea and arterial hypoxemia are the common clinical symptoms and signs in patients with such complications. In these patients, intrathoracic complications most often develop during the course of hepatic disease, but a few patients may be seen first with respiratory symptoms or radiographic abnormalities. Therefore, radiologists should be made aware of these disorders that occur in patients with chronic liver disease. In this article, the authors describe and illustrate the clinical and imaging spectrum of thoracic abnormalities associated with advanced liver disease and portal hypertension.

Inferior pulmonary ligament lymphadenopathy: demonstration by computed tomography

Inferior pulmonary ligament lymphadenopathy is common in bronchogenic carcinoma and may also occur in lymphoma and potentially in any condition which may cause intrathoracic lymphadenopathy. Despite the apparent frequency with which inferior pulmonary ligament lymphadenopathy occurs, we have been unable to find a description of the computed tomographic findings of this condition. In a patient with lymphoma, we found inferior pulmonary ligament lymphadenopathy by computed tomography as an oval, elongated soft-tissue density arising within the inferior pulmonary ligament and still attached to the mediastinum by a piece of the normal ligament. We believe that this appearance should be sufficient for the correct computed tomographic diagnosis of inferior pulmonary ligament lymphadenopathy.