CTICasesSystemic-to-Pulmonary Venous Collaterals Secondary to Severe Pulmonary Hypertension
Imaging findings
CT reveals extensive mediastinal and chest wall collaterals, particularly prominent along the intercostals. There is poor opacification of the right heart, but contrast is present in the left atrium and aorta. A jet of contrast is observed entering the left atrium from a pulmonary vein that anastomoses to these mediastinal collaterals, despite a patent superior vena cava.
Key takeaways
This is a striking case demonstrating the development of systemic-to-pulmonary venous collaterals in the setting of severe pulmonary hypertension, where right heart pressures are systemic. The collateralization mimics SVC syndrome but is physiologically driven by high pulmonary pressures rather than mechanical obstruction, allowing systemic venous blood to shunt into the pulmonary venous system and then to the left atrium.
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