Porto-systemic Shunt Due to Superior Vena Cava Obstruction Caused by A Haemodialysis Catheter: A Rare Presentation

Year 2020, Volume: 21 Issue: 1, 80 - 82, 29.05.2020

Yasemin Durum Polat , Amir Hossein Navaei Kutsi Köseoğlu

Abstract

In patients with superior vena cava (SVC) obstruction, arterial phase focal contrast enhancement of the left lobe of the liver might be observed upon computed tomography (CT). Herein, we present the case of a 52-year-old patient with SVC obstruction with an area of increased contrast enhancement (or hot spot sign) within the left lobe of the liver due to the formation of collateral circulation detected via multi-detector CT using multiplanar and three-dimensional volume imaging techniques. With this case, we aimed to emphasise that abnormal arterial phase enhancement of the left lobe of the liver might be observed upon CT in patients with SVC obstruction and should not be misinterpreted as a hepatic lesion or metastasis. The importance of this case is that it shows how to differentiate CT findings of focal contrast enhancement of the liver due to venous shunt formation from those of metastasis in patients with a high risk of liver metastasis.

Keywords

Superior vena cava obstruction , systemicto-portal shunt , “hot spot” sign

References

• 1. Grayet D, Ghaye B, Szapiro D, Dondelinger RF. Systemic-to-pulmonary venous shunt in superior vena cava obstruction revealed on dynamic helical CT. AJR Am J Roentgenol 2001; 176: 211-3.
• 2. Maldjian PD, Obolevich AT, Cho KC. Focal enhancement of the liver on CT: a sign of SVC obstruction. J Comput Assist Tomogr 1995; 19: 316-8.
• 3. Kapur S, Paik E, Rezaei A, Vu DN. Where there is blood, there is a way: unusual collateral vessels in superior and inferior vena cava obstruction. Radiographics 2010; 30: 67-78.
• 4. Muramatsu T, Miyamae T, Mashimo M, Suzuki K, Kinoshita S, Dohi Y. Hot spots on liver scans associated with superior or inferior vena caval obstruction. Clin Nucl Med 1994; 19: 622-9.
• 5. Breen DJ, Rutherford EE, Stedman B, Lee-Elliott C, Hacking CN. Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver. Eur Radiol 2004; 14: 2249-60.
• 6. Baba Y, Ohkubo K, Nakai H, Hamada K, Hokotate H, Nakajo M. Focal enhanced areas of the liver on computed tomography in a patient with superior vena cava obstruction. Cardiovasc Intervent Radiol 1999; 22: 69-70.
• 7. Dickson AM. The focal hepatic hot spot sign. Radiology 2005; 237: 647-8.