Esophageal Variceal Tangle Mimicking a Mediastinal Mass in Cirrhotic Patients

We present a case of a 71-year-old man with a history of liver cirrhosis secondary to NAFLD, esophageal varices and portal vein thrombosis, who was scheduled for a liver transplant. A follow-up CT scan demonstrated a non-enhancing soft tissue density mass in the posterior mediastinum. The mass had increased in size since first described six years earlier. The liver transplant was postponed for further evaluation.

An endoscopic ultrasound guided biopsy yielded non-informative tissue pathology. Before performing CT guided FNB, mediastinal MRI was carried out due to suspicion of a variceal tangle. It showed serpiginous structures with signal voids in T2 sequences inside the mass connecting it to known varices.

Thus, a diagnosis of mediastinal varices was established, and further diagnostic intervention was avoided.

An additional case of variceal structures mimicking a mediastinal mass is presented alongside a review of the characteristic appearance of mediastinal variceal structures, diagnostic pitfalls and hazards.