Hepatic pseudolesion due to superior vena cava obstruction

Case contributed by Dr. Muhammad Imran Khan

Presentation

Smoker with finger clubbing. Stigmata of SVC obstruction with spider nevi on chest. Distended neck veins and swollen face.

Patient Data

Age: 50 years
Gender: Female
X-ray

Initial chest radiograph

2.4 cm rounded soft tissue density nodule in right mid zone. Small nodules in right upper zone. Small right pleural effusion. Left lung and left CP angle is clear. CT was advised for further workup. 

Primary bronchogenic carcinoma anterosuperior region of mediastinum with multiple pulmonary deposits and infiltration of superior vena cava causing obstruction with collaterals.

Below the diaphragm: Pseudolesion in segment 4 of liver due to superior vena cava obstruction. 

Case Discussion

Two different densities are identified within the area of avid enhancement in segment 4 of the liver secondary to direct hepatic parenchymal perfusion and drainage into the branches of portal veins. This is due to abnormal contrast accumulation as a result of superior vena cava obstruction secondary to malignant primary bronchogenic carcinoma and collateral formation. This is in keeping with a pseudolesion of the liver, which is well documented in patients with superior vena cava obstruction. 

I am thankful to Dr. Shahid Hussain (consultant radiologist) and Dr. Esther Eden for their input.

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Case information

rID: 76001
Published: 13th Apr 2020
Last edited: 15th Feb 2021
Inclusion in quiz mode: Included
Institution: Birmingham heartlands hospital

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