Cardiophrenic varices in portal hypertension: Evaluation with CT

PURPOSE: To determine the prevalence and appearance of cardiophrenic angle (CPA) varices at computed tomography (CT) in patients with portal hypertension (PHT). MATERIALS AND METHODS: A retrospective review was performed of 148 consecutive contrast material-enhanced abdominal CT scans of patients with PHT. The paracardiac region was assessed for tubular structures suggestive of varices. Variceal diameter and CT attenuation relative to adjacent liver were noted. RESULTS: Tubular structures consistent with CPA varices were noted in 29 cases and were more common on the right side than on the left. Mean CPA variceal diameter was 2.6 mm. In three cases, right CPA varices measured 10-13 mm in diameter, but no variceal enhancement was noted on initial dynamic CT images. Delayed CT demonstrated contrast enhancement that reflected delayed enhancement of the portal venous system. CONCLUSION: CPA varices, particularly on the right side, are not uncommon in patients with PHT. Varices should be considered and excluded as a cause of CPA masses, particularly before percutaneous biopsy. Delayed CT may be necessary to correctly delineate CPA varices.