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Cavoportal shunt in superior vena cava obstruction
Gastroentérologie Clinique et Biologique (2010) 34, 242—243
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Cavoportal shunt in superior vena cava obstruction Dérivation cavoporte secondaire à une thrombose cave supérieure S. El Mouhadi , L. Arrivé ∗ Service de radiologie, hôpital Saint-Antoine, Assistance publique—Hôpitaux de Paris, faculté de médecine Pierre et Marie-Curie, université Paris VI, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France Available online 27 May 2010
A 54-year-old woman with history of clear cell ovarian adenocarcinoma presented with cough, chest discomfort and right arm swelling. After bilateral ovariectomy and hysterectomy, systemic chemotherapy with cisplatin and epirubicin was administrated by central venous catheter placed within right subclavian vein. Physical examination confirmed edema of the face and arms. O2 saturation was 96,6% at room air. Spiral CT was performed to rule out pulmonary emboli. Superior vena cava was obstructed (arrow) at the level of the aortic arch. Prominent azygos vein was demonstrated (arrowhead) (Fig. 1a). On lower level, a wedge-shaped hyperenhancement (arrows) of segment IV of the liver was demonstrated (Fig. 1b). Prominent collateral vessels (small
∗
arrows) in the anterior and lateral abdominal wall and a recanalized paraombilical vein (arrowhead) were demonstrated. This pattern corresponds to the caval—superficial— ombilical—portal pathway unusually observed in superior vena cava thrombosis. The patient was anticoagulated. Her symptoms improved and she was discharged on coumadin. In case of superior vena cava obstruction, several venous collateral pathways develop to allow blood to return to the right atrium. In addition to cavo-caval shunt, cavoportal shunt could be observed [1]. Intense opacification of the anterior quadrate lobe is observed in case of caval—superficial—ombilical—portal pathway [1]. Position and shape of the area of enhancement are characteristic and should not be mistaken for a hypervascular tumor.
Corresponding author. E-mail address: [email protected] (L. Arrivé).
0399-8320/$ – see front matter © 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.gcb.2010.03.012
Cavoportal shunt in superior vena cava obstruction
243
Conflict of interest The authors have not declared any conflict of interest.
Reference [1] Dahan H, Arrivé L, Monnier-Cholley L, Le Hir P, Zins M, Tubiana JM. Cavoportal collateral pathways in vena cava obstruction: imaging features. AJR Am J Roentgenol 1998;171:1405—11.
Figure 1
SVC obstruction.
IMAGE OF THE MONTH
Cavoportal shunt in superior vena cava obstruction Dérivation cavoporte secondaire à une thrombose cave supérieure S. El Mouhadi , L. Arrivé ∗ Service de radiologie, hôpital Saint-Antoine, Assistance publique—Hôpitaux de Paris, faculté de médecine Pierre et Marie-Curie, université Paris VI, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France Available online 27 May 2010
A 54-year-old woman with history of clear cell ovarian adenocarcinoma presented with cough, chest discomfort and right arm swelling. After bilateral ovariectomy and hysterectomy, systemic chemotherapy with cisplatin and epirubicin was administrated by central venous catheter placed within right subclavian vein. Physical examination confirmed edema of the face and arms. O2 saturation was 96,6% at room air. Spiral CT was performed to rule out pulmonary emboli. Superior vena cava was obstructed (arrow) at the level of the aortic arch. Prominent azygos vein was demonstrated (arrowhead) (Fig. 1a). On lower level, a wedge-shaped hyperenhancement (arrows) of segment IV of the liver was demonstrated (Fig. 1b). Prominent collateral vessels (small
∗
arrows) in the anterior and lateral abdominal wall and a recanalized paraombilical vein (arrowhead) were demonstrated. This pattern corresponds to the caval—superficial— ombilical—portal pathway unusually observed in superior vena cava thrombosis. The patient was anticoagulated. Her symptoms improved and she was discharged on coumadin. In case of superior vena cava obstruction, several venous collateral pathways develop to allow blood to return to the right atrium. In addition to cavo-caval shunt, cavoportal shunt could be observed [1]. Intense opacification of the anterior quadrate lobe is observed in case of caval—superficial—ombilical—portal pathway [1]. Position and shape of the area of enhancement are characteristic and should not be mistaken for a hypervascular tumor.
Corresponding author. E-mail address: [email protected] (L. Arrivé).
0399-8320/$ – see front matter © 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.gcb.2010.03.012
Cavoportal shunt in superior vena cava obstruction
243
Conflict of interest The authors have not declared any conflict of interest.
Reference [1] Dahan H, Arrivé L, Monnier-Cholley L, Le Hir P, Zins M, Tubiana JM. Cavoportal collateral pathways in vena cava obstruction: imaging features. AJR Am J Roentgenol 1998;171:1405—11.
Figure 1
SVC obstruction.