PMC4789411_01
Enhanced axial chest CT image (a) and oblique axial thin-slab maximum-intensity-projection (MIP) images (b, c) inferior to (a) show thrombosed and stenosed SVC (arrowhead) and distended and occluded azygos vein (black block arrow). There are chest wall, accessory hemiazygos, and paravertebral, intense mediastinal venous collaterals (short arrows). Central superior pulmonary veins (black asterisks) are opacified through adjacent collateral (long white arrows) as compared to nonopacified peripheral portions (white asterisks). Note the contrast filled aorta (white block arrow).
CRIRA2016-2092084.001.jpg
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fig1
Furthermore, the exam showed numerous strongly enhancing multiple hilar, mediastinal, and pericardial venous plexus around the bronchi, pulmonary arteries, and pulmonary veins with subtle early filling of the central pulmonary veins as compared to peripheral segments leading to the left heart chambers and aorta with early opacification (Figure 1).
Anterior and posterior static head images of lung perfusion scan images with Tc-99m macroaggregated albumin (MAA) show focal tracer uptake noted at the region of brain (white arrows) and stomach and faint renal uptake (not shown) indicative of right-to-left shunt.
CRIRA2016-2092084.002.jpg
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fig2
Lung perfusion scan with Tc-99m MAA was performed and showed focal tracer uptake at the region of the brain, stomach, and both kidneys indicating right-to-left shunt (Figure 2).