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

Abstract

Superior vena cava (SVC) occlusion is known to have multiple etiologies in adults but is a rare finding in children.1Reechaipichitkul W Thongpaen S Etiology and outcome of superior vena cava (SVC) obstruction in adults.Southeast Asian J Trop Med Public Health. 2004; 35: 453-457PubMed Google Scholar 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.2Siegel MJ Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population.Radiology. 2003; 229: 641-650Crossref PubMed Scopus (153) Google Scholar 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.3Cihangiroglu M Lin BH Dachman AH Collateral pathways in superior vena caval obstruction as seen on CT.J Comput Assist Tomogr. 2001; 25: 1-8Crossref PubMed Scopus (30) Google Scholar 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.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.View Large Image Figure ViewerDownload (PPT)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.View Large Image Figure ViewerDownload (PPT)