Presentation
PICC insertion for chemotherapy for recurrent cancer.
Patient Data
Complete stenosis of the left brachiocephalic vein with collateral venous return via the hemiazygos-azygos and paravertebral systems.
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 etiology in this case as the patient has a history of radiation therapy for breast cancer.
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