CTICasesSystemic-to-Left Atrial Venous Collaterals in Central Venous Obstruction
Imaging findings
Chest CT in a patient with sickle-cell disease and central venous catheter-induced SVC obstruction shows a stent in the superior vena cava. Multiple collateral venous pathways are present, including prominent superficial collateral veins and, notably, anomalous veins traversing the left pleural space through a chronic pleural effusion to connect chest wall systemic veins with the pulmonary veins and the left atrium.
Key takeaways
In the setting of chronic superior vena cava or central venous obstruction, numerous systemic venous collateral pathways develop to return blood to the heart. Rare collateral pathways include systemic-to-pulmonary venous shunts where chest wall or mediastinal veins connect with the pulmonary veins, draining directly into the left atrium. This results in a right-to-left shunt that bypasses the lungs and can be visualized as anomalous vessels traversing the pleural space.
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