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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181c2fca2
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Pericardial Varices Secondary to Superior Vena Cava Obstruction

O'Brien, Julie MB, BCh, BAO, FFR (RCSI)*; Enright, Helen MB, BCh, BAO, MRCP†; Hamilton, Samuel MB, BCh, BAO, FFR (RCPI)*

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Departments of *Radiology, and †Haematology, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.

Disclosure: The authors declare no conflict of interest.

Address for correspondence: Dr. Julie O'Brien, MB, BCh, BAO, FFR (RCSI), Department of Radiology, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. E-mail: juliemobrien@gmail.com

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CASE

A 28-year-old woman was admitted for investigation of general malaise, weight loss, and occasional dyspnoea. A comprehensive workup confirmed a diagnosis of Hodgkin's lymphoma, and she was commenced on the relevant treatment regimen. This involved the adriamycin (doxorubicin), bleomycin, vincristine, and dacarbazine regimen.

A computed tomography scan, performed initially for diagnosis and staging of her disease, revealed mediastinal lymphadenopathy with subsequent pressure effects on the superior vena cava (SVC). This resulted in collateral filling of the azygos system and the presence of linear areas of high attenuation along the lateral surface of the pericardium. These were consistent with enhancement of collateral pericardial veins (Figures 1–3).

Figure 1
Figure 1
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Figure 2
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Figure 3
Figure 3
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In SVC obstruction, collateral circulation develops in superficial and deep systems. Thoraco-epigastric and intercostals veins comprise the superficial system, and regarding the deep system, there are four main channels of collateral vessels involved; the azygos, internal mammary, lateral thoracic, and vertebral venous pathways.1

Pericardial collaterals occur as part of deep venous drainage of the thorax in response to occlusion of the SVC,2 however, they are very rarely seen.

In such a case, alerting the physician is important before catheterization, which may result in catheter misplacement or perforation of a vessel.

Follow-up imaging has confirmed a satisfactory response to treatment.

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REFERENCES

1. Lawler LP, Fishman EK. Pericardial varices: depiction on three-dimensional CT angiography. AJR Am J Roentgenol 2001;177:202–204.

2. Trigaux J-P, Van Beers B. Thoracic collateral venous channels: normal and pathologic CT findings. J Comput Assist Tomogr 1990;14:769–773.

© 2010International Association for the Study of Lung Cancer

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