EM REMS

I received an interesting CT Chest from one of our EM residents in a patient with SVC (Superior Vena Cava) syndrome.  The patient had a PORT in place with clot around the PORT occluding the SVC.  This is an interesting case with a couple common and a couple rare findings:

This is a complicated CT showing multiple findings:

A:  Good example of a right pleural effusion, large, seen on CT.  The patient also has a left sided effusion.

B:  Cross-section of the SVC showing the PORT cath and clot occluding the vessel

C:  Longitudal view of the SVC, again with PORT and clot

D:  The patient had the contrast injected from a right arm peripheral IV.  There are extensive collaterals in the arm and right chest with blood flow returning through these collaterals rather than traditional axillary vein to SVC.

E:  This view shows one of the collaterals actually connecting to the pulmonary vein.

Author:  Russell Jones, MD

Image Contributor:  Julie Phan, MD