PMC6180826_01
(a-d) A 66-year-old female with a history of lung and breast cancer presents with new onset abdominal pain. Contrast-enhanced CT scan of the abdomen and pelvis (a-c) reveals abnormal high attenuation within the lower thoracic vertebrae. Comparison was made with a prior study performed in 2011 (d), which showed no bone abnormality at that time. This was interpreted as new osseous metastatic disease.
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T11 and T12 vertebral bodies and posterior elements (Figure 1). This was initially attributed to recurrence of disease with new osseous involvement.
(a-d) Non-contrast positron emission tomography CT centred at the site of previous abnormal vertebral body attenuation demonstrates no 18-fludeoxyglucose-avid metastatic disease with the abnormal attenuation in question no longer apparent (a). Review of the prior contrast-enhanced CT scan in question (b-d) revealed subtle thrombus in the hemiazygos vein (arrow) with much of the abnormal attenuation centred in the basivertebral veins (c). On delayed phase, the abnormal attenuation has resolved (d).
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Careful review near the source of marrow enhancement revealed incidental thrombus in the hemiazygos vein (Figure 2).