Infraphrenic collaterals in malignant superior vena cava obstruction

Rastogi, Ruchi; Thulkar, Sanjay; Garg, Rachana; Gupta, Ajay

doi:10.1016/j.clinimag.2007.04.031

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…SVC syndrome often has an insidious onset as the body adapts to increasing SVC pressures by recruiting collateral vessels for venous return. Multiple collateral pathways can occur depending on the location of the obstruction and these pathways may change over time as the cause of the obstruction evolves, and as such, the imaging findings may be variable [3][4][5][6]. Other factors, including the site of contrast administration, timing of image acquisition, and native venous anatomy, may also impact the appearance of SVC syndrome on CT.…”

Section: Discussionmentioning

confidence: 99%

Multiple disappearing spinal lesions

Walker

Jibri

2019

Skeletal Radiol

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Section: Discussionmentioning

confidence: 99%

Multiple disappearing spinal lesions

Walker

Jibri

2019

Skeletal Radiol

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“…These include infraphrenic and hepatic parenchymal collaterals and systemic to pulmonary venous shunting [5][6][7]. Infraphrenic and hepatic parenchymal collaterals are said to be more likely if there is obstruction of the azygoatrial portion of the SVC [8]. Focal pericardial enhancement has also been…”

Section: Discussionmentioning

confidence: 99%

Vanishing bone metastases — a pitfall in the interpretation of contrast enhanced CT in patients with superior vena cava obstruction

Thomas

Oliver²,

Sudarshan³

2011

BJR

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ABSTRACT. We describe a previously unreported case of vertebral marrow enhancement owing to collateral circulation in a patient with superior vena cava obstruction. Failure to recognise this phenomenon led to the misdiagnosis of sclerotic bone metastases. We describe a patient with superior vena cava (SVC) obstruction who had retrograde filling of the thoracic and vertebral venous collateral systems, which caused enhancement of the thoracic vertebrae and was mistaken for metastatic infiltration.Several other venous collateral imaging patterns have been reported in patients with SVC obstruction, but we are not aware of any previous description of the above phenomenon, which we believe to be of general interest to radiologists. Case reportA 60-year-old male smoker presented with weight loss and clinical features suggestive of SVC obstruction. A chest radiograph showed a superior mediastinal mass and a contrast enhanced CT (CECT) of the chest and abdomen was performed using the following parameters: 64 slice Lightspeed VCT (GE Medical Systems, Milwaukee, WI), 0.625 mm source image thickness, 100 ml iodinated contrast (Ultravist 300, Schering, Berlin, Germany), via iv cannula in left antecubital fossa injected by pump at 3 ml s 21 with a 26 s delay. CT confirmed a large anterior mediastinal mass. This occluded the left brachiocephalic vein and the SVC, proximal to the azygocaval junction. Contrast filled an extensive collateral circulation involving the mediastinum, left chest wall and vertebral venous plexus, passing into the distal SVC via the azygos vein.High attenuation was observed within the vertebral bodies and left posterior elements of several upper thoracic vertebrae. This was ascribed to metastatic disease (Figure 1a,b).Following biopsy diagnosis of squamous cell carcinoma, a CT positron emission tomography (PET) staging study was performed. The non-contrast enhanced CT study showed that the upper thoracic vertebrae were normal (Figure 2). On re-examination of the initial CECT, it was noted that much of the vertebral abnormality was centred around the opacified basivertebral and the anterior vertebral body veins and it was realised that retrograde opacification of the capillary spaces within the vertebrae had been mistaken for sclerotic metastatic disease (Figure 3). DiscussionSVC obstruction is due to malignancy in 80% of cases, but is also a recognised complication of iatrogenic or noniatrogenic trauma and fibrosing mediastinitis owing to granulomatous infection, autoimmune disease or drugs [1].When SVC obstruction develops, blood is diverted via venous collaterals. Four classic collateral pathways involving the azygos and hemiazygos, internal mammary and lateral thoracic, superficial thoraco-abdominal and vertebral venous plexuses have been described and proven by venography [2][3][4]. In practice, several collateral pathways may be involved together and the specific pattern in a given patient will depend on the cause, exact location and duration of venous obstruction, along with individual variations ...

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