CTICasesAuto-pneumonectomy and SVC Obstruction due to Necrotizing Infection
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Imaging findings
Scout radiograph showed an absent left lung or pneumonectomy appearance. Non-contrast CT revealed significant mediastinal rotation, making the SVC difficult to visualize. The right main bronchus and bronchus intermedius were stretched and narrowed. A cavogram showed retrograde flow up the neck veins and subclavian, with stagnant flow, indicating SVC obstruction. Surprisingly, there were no robust collaterals.
Key takeaways
Auto-pneumonectomy resulting from a necrotizing infection (likely not TB due to rapid progression) can lead to severe mediastinal shift and traction on the SVC, causing SVC syndrome. The absence of extensive collateralization might indicate a rapid onset. The mediastinal shift can also cause post-pneumonectomy syndrome-like bronchial stretching and narrowing.
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