Interesting ImagesSuperior Vena Cava Syndrome Induced Collateral Circulation on 99mTc–Macroaggregated Albumin Lung Perfusion ScintigraphyKersting, David MD, MSc∗; Guberina, Nika MD†; Umutlu, Lale MD‡; Stuschke, Martin MD†; Hautzel, Hubertus MD∗Author Information From the Departments of ∗Nuclear Medicine †Radiotherapy ‡Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. Received for publication January 21, 2020; revision accepted April 19, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: David Kersting, MD, MSc, Department of Nuclear Medicine, University Hospital Essen, D-45147 Essen, Germany. E-mail: email@example.com. Clinical Nuclear Medicine: October 2020 - Volume 45 - Issue 10 - p e435-e438 doi: 10.1097/RLU.0000000000003127 Buy Metrics Abstract Perfusion lung scintigraphy using SPECT/CT is one mainstay in diagnosing pulmonary embolism. Although typically almost all tracer will be accumulated in the lung capillaries, occasionally abnormal uptake can be detected. As superior vena cava syndrome leads to aberrant blood flow, tracer injected to an arm vein might partly circumvent the pulmonary capillary bed and accumulate in well-perfused anatomical structures. In this case, next to the commonly described liver enhancement, more prominent pseudo-uptake of various thoracic vertebrae was observable. However, a time-related FDG PET/CT demonstrated only the hepatic pseudo-uptake. Taken together, careful assessment of superior vena cava syndrome patient studies is highly recommended. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.