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We report a case of paraesophageal varices presenting as a posterior mediastinal mass in a patient with long-standing portal hypertension and cirrhosis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiogram. We suggest that in diagnostic work-up of patients with cirrhosis and masses in mediastinum modern imaging techniques, such as dynamic CT, color Doppler sonography and MRI, are most helpful (because they can demonstrate the vascular nature of these masses and have multiplanar capabilities) and precutaneous needle biopsy may be hazardous.