This report is a reminder that portal hypertension with paraesophageal
varices can present as a retrocardiac mass on the chest radiograph. S
chistosoma mansoni, the probable etiology in this case, causes peripor
tal fibrosis and is the most common explanation for portal hypertensio
n worldwide. Modern imaging techniques were most helpful in the diagno
stic work-up, ultrasonography revealing pathognomonic hyperechoic peri
portal bands, and CT and MR imaging showing the extent of collaterals.