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Large Tracheal Varices in a Patient With Superior Vena Cava Compression

To the Editor: A 54-year-old man presented with a 3-month history of prominent blood vessels across his chest and neck. Computed tomography of the chest revealed a 4.5 3.5 cm right upper paratracheal mass encasing the superior vena cava (SVC). In addition, there was an extensive thrombosis of the right and left brachiocephalic and the right internal jugular veins. Bronchoscopy revealed multiple large varicose vessels involving the proximal trachea, more pronounced on its posterior wall (Fig. 1). A transbronchial needle aspiration of the mass was carefully performed avoiding puncture of these vessels confirming a diagnosis of adenocarcinoma of the lung. Tracheal and bronchial varices are extremely rare in the adult population. They have been described as a complication of pulmonary vein obstruction from various etiologies, congenital cardiac diseases, and with portal hypertension.1–3 These reports describe varices in the main stem bronchi and distal trachea. Because of the higher level of obstruction in the venous circulation in our patient, his varices were located in the subglottic area. In addition to mechanical compression of the SVC, our patient had thrombosis of both brachiocephalic veins, which might have contributed to the development of this extensive collateral circulation. To the best of our knowledge, this is the first report of tracheal varices in the context of SVC compression.