A 45-year-old man is brought to the emergency department after vomiting up frank blood. This has never occurred before and he reports no prior symptoms of nausea, vomiting, or ASA/ NSAID use. His past health history is significant for chronic alcoholism.On physical examination, his blood pressure is 94/73 mm Hg, heart rate 110/min, and thereare signs of chronic liver disease. He is resuscitated with IV fluids (normal saline) and undergoes urgent endoscopy which reveals the findings shown in Figure below. Which of the following is the most likely diagnosis?
High-Yield Explanation
In esophageal varices, the esophageal folds are thick and tortuous, giving rise to a wormy or worm-eaten appearance. The radiographic picture would vary with the severity of the varices, as well as the distention of the esophagus. When varices are severe, they should be appreciated in any projection. The left anterior oblique projection is most ideal for its demonstration.