The Focal Hepatic Hot Spot Sign

Dickson, Asante M.

doi:10.1148/radiol.2372031690

Cited by 38 publications

(18 citation statements)

References 6 publications

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“…This is due to diversion of blood into the internal thoracic vein then into the superior epigastric vein, subsequently to the superior vein of Sappey, which drains into the left portal vein. This collateral pathway results in increased uptake on nuclear scans and enhancement on CT scan in the superior aspect of segment 4 of the liver which may be interpreted as hepatic pseudolesions [12][13][14] (►Fig. 2).…”

Section: Superior Vena Cava Obstructionmentioning

confidence: 99%

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

Friedman

Quencer

Kishore

et al. 2017

Semin intervent Radiol

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Venous obstruction in the cancer population can result in substantial morbidity and, in extreme cases, mortality. While venous obstruction can be caused by both benign and malignant etiologies in this population, the management of malignant venous obstruction as a palliative measure can be somewhat nuanced with respect to nonprocedural and procedural management, both with respect to treatment of the underlying malignancy as well as treatment of venous hypertension, which may be associated with venous thrombosis. Symptom severity, primary malignancy, functional status, and prognosis are all fundamental to the patient workup and dictate both the timing and extent of endovascular intervention. The morbidity and mortality associated with malignant obstructions of central venous structures, specifically the superior vena cava and inferior vena cava, can be significantly improved with endovascular management in appropriately selected patients. Thus, the pertinent literature regarding the clinical presentation, workup, and endovascular management of malignant central venous obstruction syndromes, with directed attention to superior vena cava syndrome and inferior vena cava syndrome, will be reviewed in this article.

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Section: Superior Vena Cava Obstructionmentioning

confidence: 99%

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

Friedman

Quencer

Kishore

et al. 2017

Semin intervent Radiol

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“…These superficial collateral veins then communicate with a recanalized paraumbilical vein, which in turn drains in a hepatopetal fashion into the left portal vein (13). The presence of such a pathway may result in a hot spot at hepatic segment IV during nuclear medicine studies, such as 99m Tc sulfur colloid scanning or 99m Tc lung scintigraphy, or in hyperenhancement at venography or CT (Fig 5) (4,5,7,12,(19)(20)(21)(22). 2.…”

Section: Cavoportal 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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“…[5] However, the characteristic location, the wedge shape, arterial and venous phase characteristics, and associated findings of collateral vessels make this lesion highly specific as an indicator of SVC syndrome.…”

Section: Discussionmentioning

confidence: 99%

Hepatic pseudolesion in SVC obstruction - ^99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

2017

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An area of increased activity in segment IV of liver (quadrate lobe) on 99mTc-sulfur colloid (TSC) scans has been well documented in patients with superior vena cava obstruction. Similarly intense enhancement of the quadrate lobe in the arterial phase may be seen on computed tomography in patients of superior vena cava syndrome. We present this imaging finding in a case of malignant thymoma causing superior vena cava syndrome and discuss the physiological cause and importance of this sign.

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The Focal Hepatic Hot Spot Sign

Cited by 38 publications

References 6 publications

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

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

Hepatic pseudolesion in SVC obstruction - ^99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

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The Focal Hepatic Hot Spot Sign

Cited by 38 publications

References 6 publications

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

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

Hepatic pseudolesion in SVC obstruction - 99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

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Hepatic pseudolesion in SVC obstruction - ^99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography