Demographics:
37 years old, Female
Indication:
Fall, hemodialysis patient on anticoagulation
Findings
Chest
- Right IJ approach tunneled dialysis catheter with tip in the right atrium
- Nonopacification of the SVC, which is diminutive in caliber
- Multiple collateral veins in the upper chest and chest wall with a dilated azygos vein
- Mild dependent atelectasis bilaterally
- No pleural effusion or pneumothorax
Abdomen/Pelvis
- Intense enhancement in hepatic segment 4 on arterial phase imaging, which does not persist on delayed phase imaging
- Numerous low attenuation structures arising from both kidneys, several of which measure higher than simple fluid attenuation
- Bilateral renal atrophy without hydronephrosis
- Patent, prominent paraumbilical vein and numerous additional prominent collateral veins in the abdominal wall
- Mild atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute osseous findings
- Multilevel Schmorl's nodes in the lower thoracic spine
- Mild body wall edema
Diagnosis
SVC occlusion
Sample Report
No acute traumatic findings in the chest, abdomen, or pelvis.
Likely chronic SVC occlusion in this patient with a right IJ approach tunneled dialysis catheter terminating in the right atrium. Multiple collateral venous structures in the chest and abdomen. Hyperenhancement of hepatic segment 4 ("hot quadrate sign"), which is classically seen in association with SVC occlusion.
Numerous bilateral renal lesions, many of which are consistent with cysts and likely relate to dialysis. Several bilateral lesions are indeterminate, however, and can be further evaluated with renal mass protocol MRI.
Discussion