CTICasesCentral Venous Obstruction with Systemic-to-Pulmonary Collaterals and Downhill Varices
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Imaging findings
A patient with a history of renal failure, dialysis, and long-standing catheterization presents with central venous obstruction. Imaging demonstrates significant systemic-to-pulmonary venous collateral vessels, with contrast opacifying blood draining into the left atrium via superior pulmonary veins. Collateral flow also diverts inferiorly to the left renal vein and IVC, and the azygos vein shows retrograde flow. Intramural esophageal varices (downhill varices) are also noted.
Key takeaways
Central venous obstruction, often caused by chronic indwelling catheters, can lead to extensive collateralization. This includes systemic-to-pulmonary venous shunting that can bypass the SVC obstruction and drain into the left atrium, as well as retrograde flow through the azygos system, leading to downhill esophageal varices and other collateral pathways to the IVC.
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