CTICasesLow-Flow (Venous) Mediastinal Vascular Malformation
Imaging findings
A separate patient presented with a lobulated, serpiginous mediastinal lesion containing scattered chunky calcifications with a direct communication to the brachiocephalic vein. On early arterial-phase imaging the lesion is not yet well opacified; on a delayed phase (~90 seconds) it fills in, revealing a large draining vein emptying into the brachiocephalic vein without a demonstrable connection to the arterial tree, and on even more delayed imaging the lesion remains opacified, meeting criteria for a low-flow venous malformation.
Key takeaways
In contrast to the high-flow arterial lesion shown just before it, this lesion fills and washes out slowly on delayed phases and drains via a large systemic vein rather than arterial feeders, illustrating the imaging spectrum from high-flow to low-flow (venous) mediastinal vascular malformations; both share drainage into the systemic venous circulation but differ in feeding vessel size and enhancement kinetics.
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