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Systemic-to-Pulmonary Venous Shunt in Superior Vena Cava Obstruction Revealed on Dynamic Helical CT

David Grayet1, Benoit Ghaye, David Szapiro and Robert F. Dondelinger

1 All authors: Department of Medical Imaging, University Hospital Sart Tilman B35, B-4000 Liege 1, Belgium.



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  		Fig. 1A. —58-year-old man with systemic-to-pulmonary venous shunt. Helical CT scan shows tight stenosis of superior vena cava (curved arrow) and obstruction of distal part of left innominate vein (open arrow) caused by tumor encasement (T). Mediastinal venous network is densely opacified (small white arrows). Note opacification of azygos vein (thick white arrow), accessory hemiazygos vein (arrowhead), and perivertebral plexus.

 


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  		Fig. 1B. —58-year-old man with systemic-to-pulmonary venous shunt. Helical CT scan 3 cm caudal to A shows early enhancement of aorta (236 H) after IV contrast injection (pulmonary artery, 180 H). Note opacification of right internal thoracic vein (thick arrow), opacified dilated bronchial veins (arrowheads), and mediastinal venous network (small arrows).

 


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  		Fig. 1C. —58-year-old man with systemic-to-pulmonary venous shunt. Helical CT scan 2 cm caudal to B shows left superior pulmonary vein (asterisk), dilated bronchial veins (arrowheads) and mediastinal venous network (small arrows) with higher attenuation (500 and 1250 H, respectively) than superior vena cava, pulmonary artery, and right superior pulmonary vein (180 H) (thick arrow).

 


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  		Fig. 2. —70-year-old woman with systemic-to-pulmonary venous shunt. Helical CT scan shows earlier enhancement of right branches of superior pulmonary vein (thick arrows), dilated bronchial veins (arrowheads), and mediastinal venous network (small arrow) than of aorta, left pulmonary vein (asterisk), and pulmonary artery. Aorta (192 H) shows higher attenuation than pulmonary artery (148 H), indicating presence of right-to-left shunt.

 

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