Superior vena cava obstruction

Case contributed by Dr Bruno Di Muzio

Presentation

Patient with suspected pulmonary embolism.

Patient Data

Age: 78
Gender: Male
CT

It`s possible to identify a obstructed superior vena cava with chronic thrombosis. There is an exuberant collateral venous circulation on thorax characterized by: Dilated azygos vein, dilated pericardial veins, dilated anterior thoracic vein and other smaller mediastinal veins that  drains to left renal vein and inferior vena cava. 

There is also left pleural effusion. 

No signs of pulmonary embolism. 

Case Discussion

The brachiocephalic veins, superior vena cava and azygos-hemiazygos system drain the upper extremities and the head and neck. They are connected by a rich network of smaller venous plexuses that are normally not or only barely opacified on chest CT. On superior vena cava thrombosis the blood flow diverts into this network of collateral channels. 

The development of rich collaterals protect this patient against developing the most severe symptoms of superior vena cava syndrome. 

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Case information

rID: 25765
Case created: 6th Nov 2013
Last edited: 18th Feb 2016
System: Vascular
Inclusion in quiz mode: Included

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