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.