PMC5282413_01
Axial enhanced CT image of soft tissue of the neck (a), the chest (b), and coronal enhanced CT image of soft tissue of the neck (c). There are filling defect in the left internal jugular vein (a) and subclavian vein (b), with the lumen filled with dense soft tissue (arrow). A vascular filling defect is noted in the region extending from the left internal jugular vein to the left subclavian vein, and the venous lumina are filled with dense soft tissue (arrowhead).
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fig1
On the basis of the above findings, we diagnosed the patient as having thrombosis of the left internal jugular and left subclavian veins (Figures 1(a), 1(b), and 1(c)).
Left subclavian vein angiogram before (a) and after (b) dilation. Blood flow in the left subclavian vein to the left internal jugular vein is interrupted, while inflow of contrast medium is noted into the right subclavian vein via a collateral vessel (arrowhead in (a)). The left subclavian vein is visualized as a contrast-enhanced image after the balloon dilatation (b).
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fig2
The thrombus in the left subclavian vein was found to have diminished in size, and while the blood flow in the left subclavian vein was interrupted upon elevation of the left upper extremity, the flow in the vein had improved to such an extent that the vessel became reperfused and unoccluded when the left upper limb was hung down (Figures 2(a) and 2(b)).
Histology of tumor cells in the blood clot (a)-(c). Tumor cells are seen in the blood clot (hematoxylin and eosin stain, x100 (a)). Atypical cells with eosinophilic cytoplasm showing a high N/C ratio proliferating in a papillary pattern (hematoxylin and eosin stain, x400 (b)). Note the positive (brownish) staining for estrogen receptors (Immunostaining for estrogen receptors (c)).
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fig3
Histopathologic examination of the removed thrombus revealed the presence of adenocarcinoma cells that showed positive staining for cytokeratin (AE1/AE3), ER, and PgR expressions, indicating hematogenous dissemination of malignant cells (Figures 3(a), 3(b), and 3(c)).