CTICasesLeft Brachiocephalic Vein Thrombosis with Mediastinal Fat Stranding in Lupus
Imaging findings
CT angiography in a patient with lupus and rising anti-dsDNA titers demonstrates absent opacification of the left brachiocephalic vein with extensive venous collateralization via intercostal and internal mammary vessels. The mediastinal fat surrounding the brachiocephalic vein and extending into the upper mediastinum shows diffuse stranding and edema without discrete abscess or lymphadenopathy, and the pleura demonstrate chronic thickening from prior serositis.
Key takeaways
SLE is associated with a hypercoagulable state and venous thromboembolism. Left brachiocephalic vein thrombosis may present with ipsilateral arm swelling or chest pain and is identified on CTA by absent luminal opacification and venous collateralization. Perithrombus mediastinal fat stranding and edema may represent a panniculitis-like inflammatory reaction within mediastinal fat, which has been described as a manifestation of lupus-related autoimmune inflammation extending to adipose tissue.
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