Presentation
Dyspnea.
Patient Data
Retrosternal extension of thyroid nodule from the lower pole of the right lobe of thyroid gland at the right paratracheal region with hypodense core and coarse calcifications.
This is associated with multiple metastatic enlarged mediastinal lymph nodes at the upper mediastinum and prevascular group nodes, largest measuring about 3.6 x 3 cm in maximum axial dimensions.
The superior vena cava is invaded by one of the upper mediastinal nodes forming and intraluminal soft tissue thrombus measuring about 3.5 x 4.2 x 5.6 cm in maximum AP, SS and CC dimensions. It is extending into the junction between the right and left brachiocephalic veins as well as the proximal 2.5 cm of the left brachiocephalic vein. It shows multiple enhancing vascular structures.
Dilated azygos vein, right superior intercostal vein as well as the accessory hemiazygos vein. Multiple anterior chest wall collaterals are. Multiple venous varicosities are seen within the body of lower cervical vertebrae.
Right few atelectatic bands are noted at the posterior segment of the right upper lung lobe, otherwise, no pulmonary parenchymal lesions identified.
Right minimal pleural effusion is noted.
Bilateral elastofibroma dorsi.
Multiple old healed rib fractures are noted at the right 3rd, 4th, 5th, 6th and 7th ribs as well as the left 5th rib.
Case Discussion
Radiological features are in keeping with partial superior vena cava obstruction by tumor thrombus extending from metastatic mediastinal lymph nodes from thyroid cancer. Thyroid cancer can give metastatic nodes at the superior mediastinum along their lymphatic drainage.
Superior vena cava obstruction by invasion with malignancy affecting mediastinum represents ~90% of cases of SVC syndrome, lung cancer, and lymphoma are common causes. Metastatic lymph nodes can also invade SVC forming tumor thrombus.
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