Superior Vena Cava Syndrome Resulting in Osseous Venous Congestion Simulating Sclerotic Bone Lesions

Jesinger, Robert A.; Huynh, Bang; Gover, David D.

doi:10.2214/ajr.08.2068

Cited by 13 publications

(5 citation statements)

References 3 publications

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“…The distended contrast-filled dilated capillaries at the basivertebral anastomotic sites are thought to account for foci of increased attenuation within the bone marrow seen in this patient's initial arterial phase CT. Previous reports of this rare phenomenon are few [8][9][10].…”

Section: Discussionmentioning

confidence: 95%

Multiple disappearing spinal lesions

Walker

Jibri

2019

Skeletal Radiol

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Section: Discussionmentioning

confidence: 95%

Multiple disappearing spinal lesions

Walker

Jibri

2019

Skeletal Radiol

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“…However, bone involvement is uncommon. Only, two cases of cervical vertebral bone high-density abnormalities have been described in the context of superior vena cava syndrome secondary to a mediastinal mass (epidermoid lung carcinoma and small-cell lung carcinoma) [6,7]. To our knowledge, there are no reports of similar cases of vertebral marrow abnormalities in asymptomatic patients, without any mass syndrome or obstructed superior cava vein.…”

Section: Discussionmentioning

confidence: 98%

Transient high density vertebral bone lesions

et al. 2013

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DiagnosisBone marrow enhancement by retrograde contrast filling through collateral veins due to a left brachiocephalic vein thrombosis. DiscussionThe contrast-enhanced CT examination revealed sclerotic-like lesions associated with consecutive anterior and posterior elements from the fourth cervical vertebra to the fifth thoracic vertebra, without any lytic components, which could at first be considered as bony metastases (Fig. 1a-b). CT scan also highlighted significant collateral venous circulation secondary to a brachiocephalic left venous thrombosis. A PET-CT performed at the same time was negative. A non-contrast CT scan performed 10 days later did not reveal the initially noted bone lesions (Fig. 2a-b) and suggested diagnosis of intraosseous venous contrast media. The 1-year non-contrast CT follow-up did not show any progression of the disease.Given the lack of corresponding findings on the unenhanced CT, in the setting of central venous obstruction and collateral pathway formation, the high-attenuation lesions seen on the enhanced CT examination can be explained by the presence of intraosseous venous collaterals. In fact, the left brachiocephalic vein obstruction was responsible for the development of an extensive collateral venous pathway (Fig. 2c-d) involving the mediastinum, anterior jugular veins, anterior, and basivertebral venous plexi. The venous pressure in the dilated capillaries allowed marrow enhancement through the anastomosis capillary sites: basivertebral veins bed (between the anterior external plexus and the posterior internal plexi) and pedicular sites (between the intervertebral veins and the vertebral plexi) (Fig. 3a-b). Our patient remained asymptomatic despite the huge collateral venous substitution. The rate of injection of contrast and the time of image acquisition following contrast injection might be factors influencing the appearance of these findings.

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“…In literature, there are limited number of case reports describing such vanishing bone metastases. One of the first descriptions of this peculiar aspect was in 2009 by Jesinger and colleagues [ 2 ]. It was further illustrated in 2021 by Fukamizu and his team [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we can conclude that the dense intravertebral images on the contrast-enhanced CT imaging resulted well from contrast accumulation in intravertebral venous collaterals [ 2 ].…”

Section: Case Historymentioning

confidence: 99%