CTICasesSVC Syndrome with Venous-Enhancement Pseudo-Sclerotic Bone Metastases
Imaging findings
In a patient with pancreatic cancer and an indwelling central venous catheter, a contrast-enhanced CT shows multiple contiguous sclerotic-appearing lower thoracic vertebral bodies with prominent azygos and chest-wall venous collaterals; a subsequent non-contrast PET performed only two days later shows that all of the sclerotic-appearing bone lesions have resolved. The catheter is associated with thrombus causing SVC narrowing, accounting for the extensive collateral venous network.
Key takeaways
Sclerotic-appearing vertebral bodies that disappear on a non-contrast study are not true osseous metastases but reflect venous plexus contrast pooling from SVC obstruction -- a recognized pitfall that should be suspected whenever prominent azygos and chest-wall collaterals accompany catheter-associated central venous thrombus, even when the collateral pattern extends unusually low into the thoracic spine.
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