Korean J Radiol.  2014 Apr;15(2):185-187. 10.3348/kjr.2014.15.2.185.

Superior Vena Cava Syndrome Associated with Right-to-Left Shunt through Systemic-to-Pulmonary Venous Collaterals

Affiliations
  • 1Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. yjuan@partners.org
  • 2Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan 333, Taiwan.
  • 3Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
  • 4Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Keelung 204, Taiwan.

Abstract

Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation.

Keyword

Superior vena cava syndrome; Pulmonary venous collaterals; Computed tomography

MeSH Terms

*Collateral Circulation/physiology
Female
Humans
Middle Aged
Multidetector Computed Tomography
Phlebography/methods
Pulmonary Veins/physiopathology/*radiography
Stroke/complications
Superior Vena Cava Syndrome/physiopathology/*radiography
Veins/physiopathology

Figure

  • Fig. 1 Multidetector computed tomographic venography images of chest in 54-year-old woman with complete SVC obstruction and abundant venous collaterals. A. Coronal reformatted image demonstrates complete chronic SVC obstruction with abundant adjacent mediastinal collateral venous drainage (white thin arrow). B-D. Axial (B) and oblique sagittal maximum-intensity-projection images (C) along with volume-rendered images (D) reveal multiple venous collaterals in chest wall (white bold arrows) and paravertebral regions (arrowhead), representing involvement of lateral thoracic and paravertebral collateral pathways. Note dense contrast in patent left-sided venous collaterals (yellow bold arrow, B-D) extending from chest wall, crossing pleura, subpleural pulmonary veins and lingular lobe before draining into left superior pulmonary vein, which is consistent with connections between lateral thoracic pathway and systemic-to-pulmonary venous collateral pathway and bridging subpleural pulmonary veins. SVC = superior vena cava


Reference

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