Left brachiocephalic vein occlusion

Case contributed by Dr Henry Knipe

Presentation

PICC insertion for chemotherapy for recurrent cancer.

Patient Data

Age: 30
Gender: Female
Modality: DSA (angiography)

Complete stenosis of the left brachiocephalic vein with collateral venous return via the hemiazygos-azygos and paravertebral systems.

Comparison study from three weeks prior

Modality: CT

Radiation fibrosis affects the right upper lobe (better seen on lung windows - not shown).

The left brachiocephalic vein is near completely occluded with only a thin strip of contrast evident just anterior to the origin of the great vessels/aortic arch.

Case Discussion

Brachiocephalic vein occlusion in this case appears chronic given the distension of the hemiazygos-azygos collateral return.

Veins are thought to be the least radiosensitive of the all the blood vessels but cases of superior vena cava obstruction secondary to radiotherapy-induced fibrosis have been reported, which is the most likely aetiology in this case as the patient has a history of radiation therapy for breast cancer. 

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Case Information

rID: 30080
Case created: 17th Jul 2014
Last edited: 20th Nov 2016
Inclusion in quiz mode: Included

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