CTICasesSVC and IVC Obstruction with Systemic-to-Pulmonary Venous Collaterals
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Imaging findings
Computed tomography in a patient on long-standing hemodialysis shows chronic occlusion of both the superior vena cava (SVC) and the inferior vena cava (IVC), the latter containing a chronically occluded stent. Extensive systemic venous collaterals are present, with prominent systemic-to-pulmonary venous collaterals draining directly into the pulmonary veins via the bronchial and mediastinal venous plexuses, bypassing the right heart and creating a right-to-left shunt.
Key takeaways
Chronic, bilateral obstruction of the SVC and IVC is a vascular access nightmare that forces the development of extensive collateral pathways. Systemic-to-pulmonary venous collaterals can direct systemic venous blood into the pulmonary veins, causing a right-to-left shunt and hypoxemia, which may require lifelong anticoagulation due to the risk of paradoxical embolization.
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