Systemic to pulmonary venous communication (right-to-left shunt) in superior vena cava obstruction demonstrated by spiral CT.

Ho, Hung-Chin; Horowitz, Ada; Ho, Andrew

doi:10.1259/bjr.72.859.10624332

Cited by 21 publications

(16 citation statements)

References 4 publications

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“…The systemic-to-pulmonary venous collateral pathway is an uncommon result of SVC obstruction (1,2,5,(8)(9)(10)(11). The presence of such collateral vessels results in a right-to-left shunt, subsequently leaving the patient susceptible to stroke, brain abscess, and a high cardiac output state (4).…”

Section: Systemic-to-pulmonary Venous Collateral Pathwaymentioning

confidence: 99%

Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction

Kapur

Paik²,

Rezaei³

et al. 2010

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Obstruction of the superior vena cava (SVC) or inferior vena cava (IVC) is most commonly an acquired condition, typically caused by malignancy, benign conditions such as mediastinal fibrosis, and iatrogenic causes such as venous catheterization. In the event of chronic occlusion, collateral pathways must develop to maintain venous drainage. The major collateral pathways seen with SVC or IVC obstruction are well described and include the azygos-hemiazygos, internal and external mammary, lateral thoracic, and vertebral pathways. In addition, several unusual collateral pathways may be seen with SVC or IVC obstruction; these include systemic-to-pulmonary venous, cavoportal, and intrahepatic collateral pathways. In patients with systemic-to-pulmonary venous collateral vessels, the systemic veins drain directly into the left side of the heart, resulting in a right-to-left shunt. The collateral veins consist of mediastinal connections between the innominate veins and the superior pulmonary veins through bronchial venous plexuses around the airways, hilar vessels, and pleura. The cavoportal collateral pathways consist of collateral formation between the SVC or IVC and a tributary to the portal system. They include the caval-superficial-umbilical-portal pathway, caval-mammary-phrenic-hepatic capsule-portal pathway, caval-mesenteric-portal pathway, caval-renal-portal pathway, caval-retroperitoneal-portal pathway, and intrahepatic cavoportal pathway. These types of collateral pathways may result in unusual enhancement patterns in the liver. An understanding of these unusual collateral pathways is essential in a patient with caval occlusion who presents with signs and symptoms of a right-to-left shunt or has unusual enhancing lesions in the liver.

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Section: Systemic-to-pulmonary Venous Collateral Pathwaymentioning

confidence: 99%

Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction

Kapur

Paik²,

Rezaei³

et al. 2010

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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].…”

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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“…This syndrome is a very common complication of lung cancer or lymphoma [3,19]. Because the superior vena cava (SVC) is surrounded by many different types of tissue whose density varies, the diagnosis of SVCS is often based imaging methods other than ultrasonography [9,14]. Some studies on this disease were performed with transesophageal echocardiography [2], but most of the relevant literature is case reports [15].…”

Section: Introductionmentioning

confidence: 99%

Establishment of a Rabbit Model of Superior Vena Cava Obstruction

Duan

Liu

et al. 2007

Exp. Anim.

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Systemic to pulmonary venous communication (right-to-left shunt) in superior vena cava obstruction demonstrated by spiral CT.

Cited by 21 publications

References 4 publications

Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction

Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction

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

Establishment of a Rabbit Model of Superior Vena Cava Obstruction

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