A 55-year-old man with known cirrhosis presents with haematemesis. Barium swallow shows multiple serpiginous, nodular filling defects in the lower third of the oesophagus that change shape with peristalsis and Valsalva manoeuvre. Which diagnosis do these findings represent?

• A Reflux oesophagitis
• B Oesophageal varices ✓
• C Superficial spreading carcinoma
• D Candida oesophagitis

Explanation

The classic barium appearance of oesophageal varices is serpiginous, tortuous, longitudinal filling defects in the lower two-thirds of the oesophagus that change shape with peristalsis, swallowing, and Valsalma, because they are submucosal vascular channels that distend and collapse dynamically. Reflux oesophagitis shows mucosal granularity and discrete ulcers, not longitudinal serpiginous defects. Candida oesophagitis shows discrete, plaquelike lesions with normal intervening mucosa. Superficial spreading carcinoma produces irregular mucosal destruction without dynamic change.

Reference: Gore and Levine's Textbook of Gastrointestinal Radiology, 4th ed.

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