Comprehensive Imaging Review of the Superior Vena Cava

Abstract

The superior vena cava (SVC) is the largest central systemic vein in the mediastinum. Imaging (ie, radiography, computed tomography [CT], magnetic resonance [MR] venography, and conventional venography) plays an important role in identifying congenital variants and pathologic conditions that affect the SVC. Knowledge of the basic embryology and anatomy of the SVC and techniques for CT, MR imaging, and conventional venography are pivotal to accurate diagnosis and clinical decision making. Congenital anomalies such as persistent left SVC, partial anomalous pulmonary venous return, and aneurysm are asymptomatic and may be discovered incidentally in patients undergoing imaging evaluation for associated cardiac abnormalities or other indications. Familiarity with congenital abnormalities is important to avoid image misinterpretation. Acquired abnormalities such as intrinsic and extrinsic strictures, fibrin sheath, thrombus, primary neoplasms, and trauma can produce mild narrowing to complete occlusion, the latter leading to SVC syndrome. Each imaging modality plays a role in evaluation of the SVC, helping to determine the site, extent, and cause of pathologic conditions and guide appropriate management. Commonly performed interventional procedures for fibrin sheath and benign and malignant strictures include low-dose thrombolytic infusion, fibrin sheath disruption, venous angioplasty, and stent placement.

Asymptomatic azygos vein overflow in a young patient with primary mediastinal seminoma

“…o jugular vein enlargement, facial, neck or upper extremity swelling, neurological signs, cough or dyspnea were detected on physical examination. A contrast enhanced CT scan performed prior to biopsy procedure detected a preazygos SVC obstruction . A mediastinal mass compressed the main bronchus and vessels of upper mediastinum (Fig ); the superior vena cava (SVC) had totally collapsed at the height of the carina.…”

“…A contrast enhanced CT scan performed prior to biopsy procedure detected a preazygos SVC obstruction. 4 A mediastinal mass compressed the main bronchus and vessels of upper mediastinum (Fig 1); the superior vena cava (SVC) had totally collapsed at the height of the carina. Collateral venous system overflow enlarged the image of the azygos vein that reached the diameter of thoracic aorta ( Fig.…”

Superior Vena Cava Syndrome in a Patient with Small-Cell Lung Cancer: A Case Report

“…Anatomically, as a thin-walled vein that courses along the right middle mediastinum [5] (Fig. 2), the SVC is readily compressed, most commonly by right-sided malignancies and lymphadenopathies and/or a thrombus within the vessel, although iatrogenic causes from intravascular devices (catheters, cardiac defibrillators, and pacemaker wires) are increasingly implicated [6].…”

Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

“…Distended venous collaterals are visible both clinically and on imaging. First described in 1757, extrinsic compression due to malignancy is the most common cause accounting for up to 95% of cases …”

“…First described in 1757, extrinsic compression due to malignancy is the most common cause accounting for up to 95% of cases. [1][2][3] Treatment options for SVCS depend on clinical presentation and the underlying disease. In mild or slowly progressive SVCS, malignant causes may be treated with chemotherapy or radiotherapy.…”