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Weekly Chest CasesArchive of Old Cases

Case No : 886 Date 2014-10-20

  • Courtesy of Na Hee Kim, Kyung Hee Lee / Inha University Hospital
  • Age/Sex 55 / M
  • Chief ComplaintKnown lung cancer (adenocarcinoma), Question: Diagnosis of vertebral lesion
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pseudopathologic vertebral body enhancement
Radiologic Findings
Superior vena cava is obstructed due to tumor thrombi.
Right paravertebral venous plexus show intense enhancement. Coronal and sagittal images show vertebral body enhancement from T9 to T12 vertebral bodies.
Brief Review
Superior vena cava (SVC) obstruction can cause the development of collateral vessels. The vertebral venous plexus is one of the four main collateral pathways because of SVC obstruction that contain the lateral thoracic, internal thoracic, and azygos veins. During contrast-enhanced thoracic computed tomography (CT), contrast material may reflux into the collaterals such as paravertebral venous plexus. Little is known of the mechanism responsible for vertebral body enhancement, but an elevated venous pressure provides a possible explanation, as a higher venous pressure might increase contrast agent reflux into a vertebral body.
Vertebral body enhancement by contrast reflux could be a mimicker of osteoblastic metastases in patients with cancer presented with SVC obstruction. Normal unenhanced CT and the presence of a connection between a vertebral body enhancement and paravertebral venous collaterals can help differentiating these pseudopathologic findings from osteoblastic metastases.
References
YK Kim, YM sung, KH Hwang et al. Pseudopathologic vertebral body enhancement in the presence of superior vena cava obstruction on computed tomography. Spine J. 2013 oct 7.pii: S1529-9430(13)01361-2. doi: 10.1016/j.spinee.2013.07.440. [Epub ahead of print]
Keywords
Vertebra, Vascular,

No. of Applicants : 67

▶ Correct Answer : 41/67,  61.2%
  • - SNUH , Korea (South) Eui Jin Hwang
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Gachon Gil hospital , Korea (South) junhyung Ann
  • - Kyoto University , Japan Akihiko Sakata
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - university of montreal , Canada Andrei Gorgos I
  • - Ajou university Hospital , Korea (South) Eun young Kim
  • - DamYang health care center , Korea (South) Jung hyun Kim
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Dongguk university Ilsan hospital , Korea (South) Tae Kim
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - University of British Columbia , Canada Amr Ajlan
  • - Inha university hospital , Korea (South) Eugene Kim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Research Hospital, The Institute of Medical Science, The University of Tokyo , Japan Toshihiro Furuta
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - 異⑸ , Korea (South) Yunhee Jang
  • - CHRU Lille , France Julien Pagniez
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - CNUH , Korea (South) Kim Soo Hyun
  • - CHU Poitiers , France CHAN paul
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - 異⑸ , Korea (South) sooncheul baek
  • - 異⑸ , Korea (South) Jung Kim
  • - sahyadri speciality hospital , India kothareddy dileepreddy
  • - Saket City Hospital , India Rajesh Gothi
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - CLCC Rennes , France nicolas gautier
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
▶ Correct Answer as Differential Diagnosis : 2/67,  3.0%
  • - Fortis Hospital , India Vaibhav Singh
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
▶ Semi-Correct Answer : 2/67,  3.0%
  • - GHICL , France manuel toledano
  • - chp st martin , France Mariotte benoit
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