Downloaded from https://academic.oup.com/jcag/article-abstract/1/3/95/4999627 by guest on 17 October 2018 Journal of the Canadian Association of Gastroenterology, 2018, 1(3), 95–96 doi: 10.1093/jcag/gwy016 Image of the Month Advance Access publication 18 May 2018 Image of the Month Esophageal Variceal Hemorrhage Secondary to Post-Polycythemic Myelofibrosis Figure 1. Upper endoscopy demonstrating medium esophageal varices with high-risk stig- mata. A fibrin clot was present at the distal aspect of one column (not shown). He also had nonbleeding gastroesophageal varices (GOV1 and GOV2) (not shown). Figure 2. Axial CT sections demonstrating massive splenomegaly with a severely dilated A 71-year-old male presented to the emergency department splenic vein. with hematochezia and a hemoglobin drop from 90 to 70 g/L. His medical history was significant for polycythemia rubra vera that transformed to myelofibrosis (MF), but there was myeloid cells or increased portal flows secondary to spleno - no known liver disease. On examination, he was hemody- megaly (3, 4). namically stable with marked splenomegaly, but he had no Small studies have shown PH develops in approximately other signs of portal hypertension (PH). Bloodwork demon- 11% of MF individuals; however, the National Comprehensive strated normal liver enzymes and function. Upper endoscopy Cancer Network provides no guidance on screening for portal showed varices (Figure 1). CT venogram revealed patent hypertension (2, 4). Traditional strategies to treat complications portal and hepatic veins with no thrombus. Massive spleno- of cirrhotic PH have been utilized for MF, including EVL, NSBB megaly (>30 cm) was noted. A severely dilated splenic vein and transjugular intrahepatic portosystemic shunting (1, 2). (2.5 cm) communicated with an enlarged portal vein (1.8 cm) Given the frequency of PH in MF and potential catastrophic (Figure 2). Endoscopic variceal ligation (EVL) was performed complications, further study should explore potential merits of and nonselective beta-blocker (NSBB) therapy was initiated endoscopic screening. before discharge. As a complication of MF, PH can occur without develop- ACKNOWLEDGEMENTS ment of portal vein thrombus (1). PH has rarely been docu- mented in post-polycythemic MF (2). The mechanism of PH DM described the case. DM and TK conducted the literature review in absence of thrombosis is proposed to be extramedullary and wrote the manuscript. TK conceived the study. IE supervised the hematopoiesis in the liver and infiltration of sinusoids with project. © The Author(s) 2018. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. 95 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact email@example.com Downloaded from https://academic.oup.com/jcag/article-abstract/1/3/95/4999627 by guest on 17 October 2018 96 Journal of the Canadian Association of Gastroenterology, 2018, Vol. 1, No. 3 Douglas Motomura, MD , Tasha Kulai, MD, References 2 3 FRCPC , and Ian Epstein, MD, FRCPC 1. Alvarez-Larrán A, Abraldes JG, Cervantes F, et al. Portal hyper- tension secondary to myelofibrosis: A study of three cases. Am J Division of General Internal Medicine, Dalhousie University, Gastroenterol 2005;100:2355–8. Halifax, Nova Scotia, Canada; Division of Digestive Care and 2. Abu-Hilal M, Tawaker J. Portal hypertension secondary to myelo- Endoscopy, Dalhousie University Halifax, Nova Scotia, Canada; fibrosis with myeloid metaplasia: A study of 13 cases. World J Division of Digestive Care and Endoscopy, Dalhousie University, Gastroenterol 2009;15:3128–33. Halifax, Nova Scotia, Canada 3. Roux D, Merlio JP, Quinton A, et al. Agnogenic myeloid meta- plasia, portal hypertension, and sinusoidal abnormalities. Correspondence: Douglas Motomura, MD, Department of Gastroenterology 1987;92:1067–72. Medicine, Dalhousie University & Nova Scotia Health Authority, 4. National Comprehensive Cancer Network. Myeloproliferative neo- QEII Health Sciences Centre, VG Site, Suite 442 Bethune plasms (Version 2.2018). <hps://w tt ww.nccn.org/store/login/login. Building , 1276 South Park Street, Halifax, NS B3H 2Y9. E-mail aspx?ReturnURL=https%3a%2f%2fwww.nccn.org%2fprofession- firstname.lastname@example.org. als%2fphysician_gls%2fpdf%2fmpn.pdf>. (Accessed March 7, 2018).
Journal of the Canadian Association of Gastroenterology – Oxford University Press
Published: May 18, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera