CTICasesPseudo Bone Metastasis from Vertebral Venous Collaterals
Imaging findings
CT chest with contrast in a patient with chronic superior vena cava (SVC) obstruction shows intense, focal sclerotic-like enhancement within the thoracic vertebral bodies. This enhancement is caused by contrast-filled dilated epidural and vertebral venous plexus collaterals, without bone destruction.
Key takeaways
In SVC obstruction, venous blood is diverted through collateral pathways, including the vertebral venous plexus. During contrast injection, high concentrations of contrast fill these venous spaces, mimicking osteoblastic bone metastases ('hot vertebral body' or pseudo-metastasis sign). Cross-referencing with non-contrast CT or MRI can confirm the vascular nature.
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