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Superior Vena Cava Syndrome in a Child and Venous Collateral Pathways: MDCT Imaging

      Superior vena cava (SVC) occlusion is known to have multiple etiologies in adults but is a rare finding in children.
      • Reechaipichitkul W
      • Thongpaen S
      Etiology and outcome of superior vena cava (SVC) obstruction in adults.
      The SVC syndrome results from obstruction of the SVC or its major tributaries by intraluminal occlusion or by extrinsic compression and/or invasion from malignant and benign diseases. Obstruction of the SVC causes elevated pressure in the veins feeding into SVC and increased or reversed blood flow through collateral vessels.
      • Siegel MJ
      Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population.
      The signs of SVC syndrome included edema of the face, neck, or upper extremities; facial flush; cyanosis of the upper body; grossly visible dilated veins in the neck; or superficial collateral vessels. Severity of the syndrome depends on the collateral vascular system development. The collateral veins may show variable location and connection, and although the SVC is obstructed in the upper thorax, abdominal, and pelvic vessels usually participate to the collateral venous pathway as well.
      • Cihangiroglu M
      • Lin BH
      • Dachman AH
      Collateral pathways in superior vena caval obstruction as seen on CT.
      Therefore, identifying and describing these circulations can be difficult. We present multidetector row CT (16-detector scanner) features of a case of SVC syndrome caused by compression of lymphadenopathies at Hodgkin lymphoma.
      A 8-year-old girl was admitted to our institute complaining swelling of neck and face and fewer also. Patient also complained of weight loss (3 kilograms) and night sweats for a month. She had previously been healthy. Physical examination revealed neck swelling and multiple enlarged, painless, and mobile lymph nodes. Laboratory showed mild anemia. Her chest radiograph showed mediastinal enlargement and computed tomography or the chest showed massive mediastinal lymphadenopathy, axillary adenopathy, and bilateral pleural effusions (Figure 1). Computed tomography showed no contrast within the SVC and contrast within enlarged collateral venous channels of the left chest and no channels on the right because of the right subclavian venous occlusion. 3D volume-rendered images (Figure 2) showed enlarged collateral venous channels over the left chest with an appearance reminiscent of the roots of a mangrove tree.
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      FIGURE 1Contrast enhanced computed tomography (axial maximal intensity projection) image showing conglomerate mediastinal adenopathy and axillary adenopathy. There is no contrast in the SVC (arrow).
      Figure thumbnail gr2
      FIGURE 2A, B, 3D volume-rendered computed tomography image with enlarged venous collateral channels on the left chest that resemble mangrove tree and no channels on the right because of the right subclavian venous occlusion.
      Figure thumbnail gr2a
      FIGURE 2A, B, 3D volume-rendered computed tomography image with enlarged venous collateral channels on the left chest that resemble mangrove tree and no channels on the right because of the right subclavian venous occlusion.

      REFERENCES

        • Reechaipichitkul W
        • Thongpaen S
        Etiology and outcome of superior vena cava (SVC) obstruction in adults.
        Southeast Asian J Trop Med Public Health. 2004; 35: 453-457
        • Siegel MJ
        Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population.
        Radiology. 2003; 229: 641-650
        • Cihangiroglu M
        • Lin BH
        • Dachman AH
        Collateral pathways in superior vena caval obstruction as seen on CT.
        J Comput Assist Tomogr. 2001; 25: 1-8