Bilateral Hematothorax without Hematemesis - an unusual Presentation of Variceal Bleeding

Variceal bleeding is a major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage occurs mainly in the gastrointestinal tract, while extraluminal bleeding is very rare . The role of extraluminal varices in the risk stratification for gastrointestinal bleeding in liver cirrhosis has been increasingly evaluated and several methods, such as endosonography and computed tomography scan (CT-scan) have been proposed as diagnostic tools for the detection of this rare but relevant entity. We describe a case of an extraluminal variceal bleeding with mediastinal hematoma and bilateral hematothorax, without hematemesis, which was successfully treated with transjugular intrahepatic portosystemic shunt (TIPS) and embolization of the mediastinal varices.

Keywords: Esophagus; Extraluminal Varices; Gastrointestinal Bleeding; Liver Cirrhosis; Portal Hypertension.