CTICasesIntraosseous Venous Collaterals Mimicking Sclerotic Bone Metastases
Imaging findings
Contrast-enhanced chest CT shows extensive paraspinal, epidural, and intraosseous venous collaterals in a patient with a thrombosed brachiocephalic vein and SVC obstruction. Sagittal reformats demonstrate branching, sclerotic-appearing lesions within the vertebral bodies that directly align with and represent contrast-filled intraosseous venous channels.
Key takeaways
In the setting of central venous obstruction or occlusion, the body can recruit vertebral and epidural venous plexuses as collateral pathways. The hyperattenuating contrast within these intraosseous venous pathways on a contrast-enhanced CT can mimic osteoblastic or sclerotic bone metastases, a critical imaging pitfall easily resolved by multiplanar reformats or comparing with non-contrast imaging.
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