CTICasesLiver Enhancement Mimicking Metastasis from SVC Obstruction with Systemic-to-Pulmonary Vein Shunting
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Imaging findings
A patient with a history of colon cancer was referred for an enhancing lesion in the left hepatic lobe suspected to be a vascular metastasis. CT with contrast showed the lesion was fed by a small, intensely opacified vessel — a manifestation of SVC obstruction, with extensive collateral circulation including superficial internal mammary and superficial epigastric veins draining via the veins of Sappey into segment 4 of the liver. Numerous small, intensely opacified systemic veins were also seen connecting with both the superior and inferior pulmonary veins, demonstrating systemic-to-pulmonary vein communications with direct contrast shunting into the left atrium.
Key takeaways
SVC obstruction can produce extensive collateral pathways, including Sappey veins supplying focal liver enhancement that mimics metastatic disease, and systemic-to-pulmonary venous shunts via bronchial-to-pulmonary vein communications returning to the left atrium. Awareness of these collateral routes is crucial to avoid misdiagnosing the hepatic finding as metastasis.
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