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Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Kim H, Chung JW, Park JH, Yin YH, Park SH, Yoon CJ, Choi YH - Korean J Radiol (2003 Jul-Sep)

Bottom Line: The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment.In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor.In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. chungjw@radcom.snu.ac.kr

ABSTRACT

Objective: To evaluate the role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Materials and methods: Eighteen patients who had undergone both CT venography and digital subtraction venography were prospectively enrolled in this study. The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment. CT venography and digital subtraction venography were compared in defined venous segments, and the degree of obstruction, and correlation was expressed using Spearman's rank correlation coefficient.

Results: In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor. Interobserver agreement regarding classification of the degree of obstruction was judged as good for CT venography (K=0.864), and in evaluating this, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs = 0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography. In half of all patients, the findings of CT venography led to changes in the treatment plan.

Conclusion: The findings of CT venography correlated closely with those of digital subtraction venography, and the former accurately depicted the degree and extent of benign venous obstruction.

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Related in: MedlinePlus

Focal stenosis of the left subclavian vein hidden behind overlapping collateral veins.A. Transverse thin-slab maximum-intensity-projection image obtained after segmentation of the left clavicle and first rib reveals severe stenosis of the left subclavian vein (arrow). Note the presence of a large overlying collateral vein (arrowhead).B. Volume-rendering image in frontal projection shows that the stenotic portion of the left subclavian vein is hidden behind the collateral vein (arrow).C. Volume-rendering image obtained at craniocaudal angulation reveals stenosis (arrow).D. At digital subtraction venography, it is difficult to recognize significant stenosis in the left subclavian vein. The prominence of the collateral veins, however, suggests the presence of hemodynamically significant stenosis.E. Digital subtraction venography performed after the catheter tip placed in the left subclavian vein has revealed severe focal stenosis (arrow) of the left subclavian vein.
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Figure 3: Focal stenosis of the left subclavian vein hidden behind overlapping collateral veins.A. Transverse thin-slab maximum-intensity-projection image obtained after segmentation of the left clavicle and first rib reveals severe stenosis of the left subclavian vein (arrow). Note the presence of a large overlying collateral vein (arrowhead).B. Volume-rendering image in frontal projection shows that the stenotic portion of the left subclavian vein is hidden behind the collateral vein (arrow).C. Volume-rendering image obtained at craniocaudal angulation reveals stenosis (arrow).D. At digital subtraction venography, it is difficult to recognize significant stenosis in the left subclavian vein. The prominence of the collateral veins, however, suggests the presence of hemodynamically significant stenosis.E. Digital subtraction venography performed after the catheter tip placed in the left subclavian vein has revealed severe focal stenosis (arrow) of the left subclavian vein.

Mentions: The causes of obstruction were intrinsic narrowing (n=10) (Figs. 1, 3), extrinsic compression of the left brachiocephalic vein between the sternum and arch vessels (n=5) (Fig. 2), venous thrombosis (n=2), and mediastinal inflammatory pseudotumor (n=1). CT venography accurately diagnosed the causes of obstruction in all patients, but digital subtraction venography failed in this respect in five patients (two with extrinsic compression, one with an inflammatory pseudotumor, one with pacemaker-induced superior vena cava obstruction associated with thrombosis, and one with Behçet's disease and diffusely obliterated thoracic central veins). In the patient with an inflammatory pseudotumor confirmed at post-surgical histopathologic examination, CT venography demonstrated an enhancing mass with internal calcification encasing the superior vena cava.


Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Kim H, Chung JW, Park JH, Yin YH, Park SH, Yoon CJ, Choi YH - Korean J Radiol (2003 Jul-Sep)

Focal stenosis of the left subclavian vein hidden behind overlapping collateral veins.A. Transverse thin-slab maximum-intensity-projection image obtained after segmentation of the left clavicle and first rib reveals severe stenosis of the left subclavian vein (arrow). Note the presence of a large overlying collateral vein (arrowhead).B. Volume-rendering image in frontal projection shows that the stenotic portion of the left subclavian vein is hidden behind the collateral vein (arrow).C. Volume-rendering image obtained at craniocaudal angulation reveals stenosis (arrow).D. At digital subtraction venography, it is difficult to recognize significant stenosis in the left subclavian vein. The prominence of the collateral veins, however, suggests the presence of hemodynamically significant stenosis.E. Digital subtraction venography performed after the catheter tip placed in the left subclavian vein has revealed severe focal stenosis (arrow) of the left subclavian vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698080&req=5

Figure 3: Focal stenosis of the left subclavian vein hidden behind overlapping collateral veins.A. Transverse thin-slab maximum-intensity-projection image obtained after segmentation of the left clavicle and first rib reveals severe stenosis of the left subclavian vein (arrow). Note the presence of a large overlying collateral vein (arrowhead).B. Volume-rendering image in frontal projection shows that the stenotic portion of the left subclavian vein is hidden behind the collateral vein (arrow).C. Volume-rendering image obtained at craniocaudal angulation reveals stenosis (arrow).D. At digital subtraction venography, it is difficult to recognize significant stenosis in the left subclavian vein. The prominence of the collateral veins, however, suggests the presence of hemodynamically significant stenosis.E. Digital subtraction venography performed after the catheter tip placed in the left subclavian vein has revealed severe focal stenosis (arrow) of the left subclavian vein.
Mentions: The causes of obstruction were intrinsic narrowing (n=10) (Figs. 1, 3), extrinsic compression of the left brachiocephalic vein between the sternum and arch vessels (n=5) (Fig. 2), venous thrombosis (n=2), and mediastinal inflammatory pseudotumor (n=1). CT venography accurately diagnosed the causes of obstruction in all patients, but digital subtraction venography failed in this respect in five patients (two with extrinsic compression, one with an inflammatory pseudotumor, one with pacemaker-induced superior vena cava obstruction associated with thrombosis, and one with Behçet's disease and diffusely obliterated thoracic central veins). In the patient with an inflammatory pseudotumor confirmed at post-surgical histopathologic examination, CT venography demonstrated an enhancing mass with internal calcification encasing the superior vena cava.

Bottom Line: The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment.In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor.In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. chungjw@radcom.snu.ac.kr

ABSTRACT

Objective: To evaluate the role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction.

Materials and methods: Eighteen patients who had undergone both CT venography and digital subtraction venography were prospectively enrolled in this study. The following features were analyzed by two observers: the cause, degree, and extent of venous obstruction; associated thrombosis; and implications for the planning of treatment. CT venography and digital subtraction venography were compared in defined venous segments, and the degree of obstruction, and correlation was expressed using Spearman's rank correlation coefficient.

Results: In all patients, CT venography depicted the causes of obstruction, including extrinsic compression of the left brachiocephalic vein, and mediastinal inflammatory pseudotumor. Interobserver agreement regarding classification of the degree of obstruction was judged as good for CT venography (K=0.864), and in evaluating this, there was significant correlation between CT venography and digital subtraction venography (reader 1: Rs = 0.58, p < 0.01; reader 2: Rs = 0.56, p < 0.01). In evaluating the status of central veins proximal to long segmental obstruction, and associated thrombosis, CT venography was superior to digital subtraction venography. In half of all patients, the findings of CT venography led to changes in the treatment plan.

Conclusion: The findings of CT venography correlated closely with those of digital subtraction venography, and the former accurately depicted the degree and extent of benign venous obstruction.

Show MeSH
Related in: MedlinePlus