Basic SciencePseudopathologic vertebral body enhancement in the presence of superior vena cava obstruction on computed tomography
Introduction
Superior vena cava (SVC) obstruction is a complication of both malignant and benign diseases that occlude the SVC and subsequently direct blood flow into collateral veins. Collaterals related to SVC obstruction are well documented in the literature and may include lateral thoracic, internal thoracic, azygos, and vertebral veins [1], [2], [3]. Unusual pathways and enhancement patterns have also been reported including breast vein engorgement, brain parenchymal enhancement, and liver parenchymal enhancement [4], [5], [6]. However, no study to our knowledge has previously demonstrated a retrograde vertebral body enhancement. The present report describes our recent observations of an unusual vertebral body enhancement in patients with SVC obstruction on thoracic computed tomography (CT).
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Materials and methods
Our institutional review board approved this retrospective research study. Patient informed consent was not required, but written informed consent was obtained from patients who underwent the enhanced CT study. A retrospective review of our radiologic database was performed to identify all patients with the obstruction of SVC or brachiocephalic vein causing reflux of contrast agent into collateral vessels and presented with an unusual vertebral body enhancement on thoracic CT. From March, 2009
Results
Thirty-nine vertebral body enhancements were found in the 13 patients, involving cervical (n=12), thoracic (n=25), or lumbar (n=2) vertebra. Multiple levels of vertebral bodies were involved in eight patients. In addition, similar enhancement was observed within the sternum in three patients (Fig. 3). Contrast enhancements within vertebral bodies were nodular (n=19) or polygonal (n=20) (Fig. 1, Fig. 2, Fig. 3). Involved areas were right lateral (n=2), central (n=14), left lateral (n=6), right
Discussion
The vertebral venous plexus is one of the four main collateral pathways because of SVC obstruction that contain the lateral thoracic, internal thoracic, and azygos veins. Usual or unusual collaterals related to SVC obstruction have been documented in plenty of literature [1], [2], [3], [4], [5], [6], [7]. However, only one case of vertebral body enhancement has been reported in the English literature [8]. In a study that reviewed 21 CT scans in SVC obstruction with collateral vessel
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Author disclosures: YKK: Nothing to disclose. YMS: Nothing to disclose. KHH: Nothing to disclose. EKC: Nothing to disclose. H-YC: Nothing to disclose.