CTICasesVertebral Venous Congestion simulating Sclerotic Metastasis (Pseudo-sclerosis)
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Imaging findings
Initial contrast-enhanced CT in a patient with SVC syndrome shows a dense, sclerotic-appearing area in a vertebral body with extensive enhancing venous collateral flow and vessels entering the bone. A follow-up CT after SVC stent placement demonstrates resolution of the SVC syndrome, diminished collaterals, and complete disappearance of the sclerotic vertebral lesion.
Key takeaways
Vertebral venous congestion, often secondary to SVC obstruction, can create a pseudo-sclerotic appearance in vertebral bodies due to extensive collateral venous flow, mimicking sclerotic metastases. This finding resolves upon alleviation of the venous obstruction (e.g., with SVC stenting). Recognition is important to avoid misdiagnosis and unnecessary workup.
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