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Weekly Chest CasesArchive of Old Cases

Case No : 1114 Date 2019-03-04

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  • Courtesy of Cherry Kim, Ki Yeol Lee / Korea university Ansan hospital
  • Age/Sex 62 / M
  • Chief Complaintbiopsy proven small cell lung cancer
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
vertebral venous congestion
Radiologic Findings
Fig 1-3. Bone window setting of the chest CT scan shows biopsy proven small cell lung cancer in the mediastinum, dilatation of azygos vein, and multiple sclerotic lesions in T10, T11, T12 vertebral bodies.
Figs 4-5. After chemotherapy, the size of tumor is decreased, and multiple sclerotic lesions were disappeared.
Brief Review
The CT diagnosis of SVC thrombosis includes a lack of enhancement of the SVC, intraluminal filling defects or narrowing, and visualization of the collateral vessels. The presence of these collateral vessels is an important CT feature for the diagnosis of SVC obstruction, with a reported sensitivity and specificity of 96% and 92%, respectively.
When SVC obstruction occurs, blood is diverted via several collateral vessels. Four classic collateral vessel pathways are commonly described, including the anterior and lateral group, the mediastinal group, the azygos and hemiazygos pathways, and the vertebral group. In fact, several collateral pathways are commonly involved, and the specific pattern depends on the cause and exact location of the obstruction and on the many individual variations in the venous anatomy. It is very difficult to predict the pattern of collateralization on the basis of the characteristics of the SVC thrombosis. Similarly, poor correlation between patient symptoms and the pattern of collateralization has been observed. In some reports, the azygos and vertebral collateral venous systems were enhanced. However, the anterior and lateral and mediastinal collateral venous pathways were also very frequently enhanced.
The paravertebral venous plexus is a small network of veins within and surrounding the vertebrae. It includes the epidural vertebral venous plexuses, external vertebral venous plexuses, basivertebral veins, and intervertebral veins. The internal portion of the plexus, the so-called venous plexus of Batson, is epidural and receives blood from the vertebral bodies via the basivertebral veins. It freely communicates with the external paravertebral venous plexuses via the intervertebral veins that pass through the spinal foramina. This paravertebral plexus constitutes several anastomoses, including the brachiocephalic, azygos, hemiazygos system, renal veins, and inferior vena cava. The epidural plexuses are located within the vertebral canal and run in a vertical direction. They can be divided into the anterior and posterior epidural plexuses, with high levels of anteroposterior communication achieved by means of multiple intervertebral veins. The external vertebral venous plexuses are divided into the ventral and dorsal plexuses by the transverse processes. The basivertebral vein enters the vertebral body and opens into the epidural venous plexus, whereas the intervertebral plexuses are located near the spinal nerves in the intervertebral foramen.
References
1. Mona Kara et al. CT Features of Vertebral Venous Congestion Simulating Sclerotic Metastases in Nine Patients With Thrombosis of the Superior Vena Cava. American Journal of Roentgenology. 2016;207: 80-86.
Keywords
SVC obstruction due to small cell lung cancer, Pseudopathologic vertebral body enhancement, mediastinum, vascular,

No. of Applicants : 80

▶ Correct Answer : 38/80,  47.5%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - Asan Medical Center , Korea (South) YURA AHN
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - , Korea (South) JANG SEONG WON
  • - Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
▶ Semi-Correct Answer : 22/80,  27.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - The University of Tokyo Hospital , Japan MASAFUMI KAIUME
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - , Japan HISATAKA ITO
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Gyeongsang National University Hospital , Korea (South) KWON HWANWOONG
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - , Japan YUMI MAEHARA
  • - Japanese Red Cross Wakayama Medical Center , Japan AKIHIKO SAKATA
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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