CTICasesSuperior Vena Cava Syndrome with Retrograde Collateral Flow through an Anomalous Pulmonary Vein
Imaging findings
In a patient with metastatic head and neck squamous cell carcinoma and a known left superior partial anomalous pulmonary venous return, a large right mediastinal mass causes superior vena cava syndrome with narrowing of the right-sided airways and occlusion of the SVC and left innominate vein. Contrast injected through the left upper extremity opacifies an extensive network of collaterals that decompress retrograde into the anomalous left upper lobe pulmonary vein, communicate with the pulmonary arteries, and ultimately reach the left atrium via the left inferior pulmonary vein.
Key takeaways
This is an unusual demonstration of retrograde collateral venous flow exploiting a pre-existing anomalous pulmonary venous connection once the superior vena cava becomes obstructed, effectively creating a physiology resembling a Glenn shunt; the complete opacification pattern could be mistaken for pulmonary embolism, and delayed imaging or lower-extremity injection would be preferable to definitively exclude true pulmonary embolism in this setting.
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