CTICasesHodgkin's Lymphoma with SVC Obstruction and Pulmonary Venous Collateralization
Imaging findings
Frontal and lateral radiographs illustrate extensive anterior mediastinal abnormality, highly suggestive of massive lymph node enlargement in a young patient. CT imaging confirms a large mediastinal mass causing central venous obstruction, leading to the formation of numerous collateral vessels. These collaterals include the superior intercostal vein, pericardiophrenic vein, and periphrenic veins. A particularly notable finding is the collateral emptying into the left pulmonary vein, indicative of a right-to-left shunt. The tumor is also observed to extend into the chest wall, causing periosteal reaction and remodeling of the sternum.
Key takeaways
Hodgkin's lymphoma is a primary consideration for a young person presenting with massive anterior mediastinal lymphadenopathy. Central venous obstruction caused by such masses can result in extensive collateral vessel formation, including unusual pathways such as shunting into the pulmonary veins, which constitutes a type of right-to-left shunt. The pericardiophrenic vein can be used for anatomical correlation, as it tracks the phrenic nerve. Chest wall involvement and bone remodeling are signs that may suggest chronicity of the disease.
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