CTICasesTranspleural Systemic-to-Pulmonary Venous Collateral in Central Venous Obstruction
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Imaging findings
Contrast-enhanced CT demonstrated central venous obstruction, with non-visualization of the left innominate vein and extensive mediastinal collateral vessels. Notably, a dilated systemic vein in the left basal hemithorax traversed the pleura to drain directly into a pulmonary vein, illustrating a transpleural systemic-to-pulmonary venous collateral. Other recruited veins, including cardiophrenic veins, drained into the IVC.
Key takeaways
Central venous obstruction can lead to the development of numerous collateral pathways to decompress the obstructed system. These can include rare transpleural collaterals where systemic veins directly shunt into pulmonary veins, bypassing the obstructed central venous system. Recognizing these collateral pathways is important in patients with central venous occlusion.
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