Case 175:   Perfusion Abnormality (THAD/THID)

Diagnostic Category:

Clinical Presentation:

29 year old female with bulky mediastinal lymphadenopathy due to Hodgkins Lymphoma.

CT: Retrograde THAD due to SVC occlusion

Imaging Findings:

This CT was performed to exclude pulmonary embolism when the patient presented with chest pain. Almost completely occluding thrombus formed around the tip of a central line in the distal superior vena cava (SVC). This caused intravenous contrast, which was injected through a power injector via the right antecubital vein, to retrogradely stain the right internal mammary vein, superior epigastric veins, superior vein of Sappey, and finally through the falciform ligament a parenchymal hepatic portion in segment 4A, where it mimics a hypervascular perfusion anomaly. This phenomenon is commonly seen with obstruction of the SVC.