Superior Vena Cava syndrome occurs when blood flow is obstructed in the superior vena cava, typically due to external compression or invasion by a lung or mediastinal malignancy (1). It presents with swelling of the face, neck, and arms due to elevated venous pressure above the obstruction (2). Diagnosis involves imaging like CT scans to locate the obstruction and identify its cause, while treatment aims to both relieve venous obstruction and address the underlying condition (3). Options for relieving obstruction include endovascular stenting, angioplasty, or surgical bypass/replacement of the superior vena cava.
This document discusses sinus of Valsalva aneurysm (SVA), which is a rare cardiac anomaly where the wall of the sinus of Valsalva is weakened, forming a bulge or outpouching. SVAs can be congenital or acquired and most commonly originate from the right coronary sinus. Unruptured SVAs may be asymptomatic but can cause complications like heart failure. Ruptured SVAs often present with sudden chest pain and heart murmur, and can lead to cardiac tamponade, arrhythmias, or sudden death if ruptured into the pericardium. Echocardiography, CT, MRI and angiography can help in diagnosis. Surgery is the standard treatment but device closure is
1. A caroticocavernous fistula is an abnormal connection between the carotid artery and cavernous sinus, allowing high pressure arterial blood to enter the low pressure venous system and compromising blood flow.
2. They can be classified based on their connection (direct vs indirect) and arterial supply (internal or external carotid artery).
3. Clinical presentation depends on flow and includes eye symptoms like proptosis as well as neurological deficits. Imaging like CTA/MRA/DSA is used for diagnosis.
4. Treatment options include endovascular embolization to occlude the fistula via a transarterial or transvenous approach or surgery like trapping the fistula. The goal is to
The caroticocavernous fistula is a specific type of dural arteriovenousfistula characterized by abnormal arteriovenous shunting within the cavernous sinus.
A caroticocavernous fistula results in high-pressure arterial blood entering the low-pressure venous cavernous sinus.
This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit.
This document provides an overview of cerebral arteriovenous malformations (AVMs). It defines a cerebral AVM as a vascular malformation with direct connections between arteries and veins, without an intervening capillary bed. The key characteristics of AVMs are described, including their demographics, clinical presentations such as hemorrhage and seizures, evaluation with imaging and angiography, grading systems like the Spetzler-Martin scale, and treatment options including surgery, embolization, and radiosurgery. Guidelines for treatment are outlined based on the grade of the AVM, with lower grade AVMs more amenable to aggressive treatment aiming for cure.
Intracranial arteriovenous malformations (AVMs) are abnormal connections between arteries and veins in the brain without an intervening capillary bed. This direct shunting of blood can cause hemorrhage. AVMs appear on imaging studies as a tangle of vessels called a nidus. Treatment depends on the size and location of the AVM and may include embolization to block blood flow, radiosurgery to damage the vessels over time, or surgery to remove the nidus. While treatment aims to prevent rebleeding, complications can include new neurological deficits or hemorrhage.
Bedside Ultrasound in Neurosurgery Part 3/3Liew Boon Seng
Ultrasound can be used to assess intracranial dural arteriovenous fistulas (DAVF) and carotid cavernous fistulas (CCF). For DAVF, ultrasound shows increased velocities in feeding arteries and decreased resistance indices, allowing assessment before and after treatment. For CCF, ultrasound reveals abnormal mosaic flow in the cavernous sinus and engorged veins with reversed flow. It can monitor hemodynamic changes and treatment response in a noninvasive manner. Ultrasound is also useful for assessing cerebral veins and sinuses, and can diagnose temporal arteritis by identifying hypoechoic wall thickening and stenoses in temporal arteries.
Superior Vena Cava syndrome occurs when blood flow is obstructed in the superior vena cava, typically due to external compression or invasion by a lung or mediastinal malignancy (1). It presents with swelling of the face, neck, and arms due to elevated venous pressure above the obstruction (2). Diagnosis involves imaging like CT scans to locate the obstruction and identify its cause, while treatment aims to both relieve venous obstruction and address the underlying condition (3). Options for relieving obstruction include endovascular stenting, angioplasty, or surgical bypass/replacement of the superior vena cava.
This document discusses sinus of Valsalva aneurysm (SVA), which is a rare cardiac anomaly where the wall of the sinus of Valsalva is weakened, forming a bulge or outpouching. SVAs can be congenital or acquired and most commonly originate from the right coronary sinus. Unruptured SVAs may be asymptomatic but can cause complications like heart failure. Ruptured SVAs often present with sudden chest pain and heart murmur, and can lead to cardiac tamponade, arrhythmias, or sudden death if ruptured into the pericardium. Echocardiography, CT, MRI and angiography can help in diagnosis. Surgery is the standard treatment but device closure is
1. A caroticocavernous fistula is an abnormal connection between the carotid artery and cavernous sinus, allowing high pressure arterial blood to enter the low pressure venous system and compromising blood flow.
2. They can be classified based on their connection (direct vs indirect) and arterial supply (internal or external carotid artery).
3. Clinical presentation depends on flow and includes eye symptoms like proptosis as well as neurological deficits. Imaging like CTA/MRA/DSA is used for diagnosis.
4. Treatment options include endovascular embolization to occlude the fistula via a transarterial or transvenous approach or surgery like trapping the fistula. The goal is to
The caroticocavernous fistula is a specific type of dural arteriovenousfistula characterized by abnormal arteriovenous shunting within the cavernous sinus.
A caroticocavernous fistula results in high-pressure arterial blood entering the low-pressure venous cavernous sinus.
This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit.
This document provides an overview of cerebral arteriovenous malformations (AVMs). It defines a cerebral AVM as a vascular malformation with direct connections between arteries and veins, without an intervening capillary bed. The key characteristics of AVMs are described, including their demographics, clinical presentations such as hemorrhage and seizures, evaluation with imaging and angiography, grading systems like the Spetzler-Martin scale, and treatment options including surgery, embolization, and radiosurgery. Guidelines for treatment are outlined based on the grade of the AVM, with lower grade AVMs more amenable to aggressive treatment aiming for cure.
Intracranial arteriovenous malformations (AVMs) are abnormal connections between arteries and veins in the brain without an intervening capillary bed. This direct shunting of blood can cause hemorrhage. AVMs appear on imaging studies as a tangle of vessels called a nidus. Treatment depends on the size and location of the AVM and may include embolization to block blood flow, radiosurgery to damage the vessels over time, or surgery to remove the nidus. While treatment aims to prevent rebleeding, complications can include new neurological deficits or hemorrhage.
Bedside Ultrasound in Neurosurgery Part 3/3Liew Boon Seng
Ultrasound can be used to assess intracranial dural arteriovenous fistulas (DAVF) and carotid cavernous fistulas (CCF). For DAVF, ultrasound shows increased velocities in feeding arteries and decreased resistance indices, allowing assessment before and after treatment. For CCF, ultrasound reveals abnormal mosaic flow in the cavernous sinus and engorged veins with reversed flow. It can monitor hemodynamic changes and treatment response in a noninvasive manner. Ultrasound is also useful for assessing cerebral veins and sinuses, and can diagnose temporal arteritis by identifying hypoechoic wall thickening and stenoses in temporal arteries.
This document discusses testicular varicoceles, which are abnormal dilations of the veins within the pampiniform plexus that surrounds the testicles. Varicoceles are found in approximately 15% of men and can cause scrotal pain or swelling. Ultrasound is the most common imaging method used to diagnose varicoceles by identifying dilated veins in the pampiniform plexus that enlarge further with maneuvers like Valsalva. Treatment options include percutaneous embolization to occlude the spermatic vein by catheterization or surgical ligation of the vein through sub-inguinal, inguinal, or retroperitoneal approaches.
Anatomy and imaging of coronary artery disease withSarbesh Tiwari
1) Coronary CT angiography (CCTA) uses computed tomography to non-invasively image the coronary arteries. It provides high quality images of the coronary arteries and their branches.
2) CCTA is performed using either electron-beam CT or multi-detector row CT (MDCT). MDCT is now more commonly used due to its wider availability and lower cost. The latest generation 64-detector MDCT allows for very high resolution imaging.
3) CCTA requires careful preparation of the patient including medication to control heart rate and dilation of the coronary arteries. The scan itself involves ECG gating to image the heart during diastasis and injection of iodinated contrast to outline the coronary
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
This document discusses various types of vascular malformations of the brain. It describes arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), developmental venous anomalies (DVAs), cavernous malformations, and capillary telangiectasias. It provides details on imaging with angiography, CT, and MRI to identify these conditions. It also discusses treatments and classifications like the Borden system for DAVFs. Common locations are the transverse/sigmoid sinus for DAVFs and presentation can include pulsatile tinnitus, cranial nerve palsies, and hemorrhage.
Digital Subtraction Neuroangiography: What a Resident Should Know Dr. Shahnawaz Alam
This document provides an overview of digital subtraction neuroangiography for residents. It begins with an introduction to the principles and importance of neuroangiography. It then provides detailed descriptions of normal neurovascular anatomy and angiographic views of the extracranial carotid system, anterior and posterior circulations. It discusses indications, contraindications, patient preparation, technique, complications and case examples to illustrate pathologies. The goal is to equip residents with the basic knowledge to interpret images and safely perform neuroangiography.
This document discusses ventricular septal defects (VSDs), including their anatomy, types, clinical presentation, diagnostic workup, and management. The key points are:
1. VSDs allow blood to pass abnormal from the left to the right ventricle. The patient presented has symptoms of a long-standing moderate VSD.
2. Echocardiography is the primary imaging modality used to characterize VSD location, size, complications like pulmonary hypertension.
3. Treatment indications for VSDs include the presence of heart failure symptoms or pulmonary hypertension. Surgical closure or catheter device closure are options.
This document discusses Superior Vena Cava Syndrome (SVCS), which is caused by obstruction of the Superior Vena Cava (SVC). Malignancies are the most common cause, especially lung cancers like non-small cell lung cancer and small cell lung cancer. Symptoms range from mild edema to life-threatening signs. Diagnosis involves imaging like CT or MRI venography. Treatment depends on the severity and cause of SVCS, but may include steroids, endovascular stenting, chemotherapy, and/or radiotherapy. The goal is prompt symptom relief while determining the best long-term management based on the underlying condition.
Central venous access devices such as nontunneled central venous catheters and peripherally inserted central catheters can be placed under imaging guidance more safely than with external landmarks alone. Nontunneled catheters are commonly placed at the bedside using local anesthesia for temporary access when patients are too ill to transport. They provide advantages over tunneled catheters in that they do not require strict coagulation parameter adherence and can be easily removed. Proper placement of catheter tips is important to avoid complications and the superior vena cava-right atrial junction is the ideal target location.
Stereotactic radiosurgery in arterio venous malformationsumesh V
Stereotactic radiosurgery (SRS) is an effective treatment for arteriovenous malformations (AVMs). SRS precisely delivers high doses of radiation to the AVM nidus, resulting in progressive occlusion of vessels within 1-3 years. Obliteration rates after SRS range from 35-92%, with higher rates for smaller AVMs receiving higher radiation doses. Careful targeting of the AVM nidus using fusion of imaging modalities is important for treatment planning. Long-term follow up with MRI is needed to monitor for obliteration and potential radiation-related effects.
This document discusses the use of cardiac CT (CCT) for evaluating non-coronary cardiac conditions. It describes how CCT can assess myocardial diseases like dilated cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia. It also discusses how CCT evaluates pericardial diseases, valvular heart disease, cardiac masses, and congenital heart defects. CCT provides high resolution images of the heart and surrounding structures and can detect abnormalities in cardiac function, morphology, and tissue characteristics.
Cardiovascular CT is a valuable tool for evaluating congenital heart disease in children. It provides high spatial and temporal resolution to depict complex anatomy. Key applications include assessing pulmonary blood flow in pulmonary atresia, vascular rings prior to surgery, coronary artery anomalies, and postoperative complications. Careful patient preparation and protocols are needed given pediatric concerns. CT enables simultaneous evaluation of vascular structures, airways, and cardiac function to comprehensively evaluate complex congenital heart disease.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It provides information needed for coronary interventions. The procedure involves accessing the femoral or radial artery and advancing a catheter into the heart to inject contrast dye and image the arteries. It can detect blockages but has limitations like vessel overlap that may obscure lesions. Complications are rare but can include artery damage, embolism, or arrhythmias.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
Segmental approach and evaluation of cardiac morphologyNizam Uddin
This document discusses the segmental approach to evaluating cardiac morphology in congenital heart disease. It describes the three major cardiac segments - atria, ventricles, and great arteries - and how any combination of anomalies in these segments can occur. It emphasizes using a step-by-step approach to characterize each segment anatomically, describe the connections between segments, and identify any associated anomalies. MRI can help clarify complex intracardiac anatomy, characterize atrial and ventricular septal defects, and evaluate postoperative patients - complementing echocardiography in the evaluation, diagnosis and management of congenital heart disease.
Normal anatomy and congenital anomalies of vena cavaeGobardhan Thapa
This document discusses the normal anatomy and common congenital anomalies of the superior and inferior vena cavae. It begins with an overview of the embryological development of the vena cavae. It then describes the normal anatomy of the superior and inferior vena cavae and their major tributaries. Common congenital anomalies are then outlined, including double superior vena cavae, left-sided superior vena cava, left inferior vena cava, double inferior vena cava, azygos continuation of the inferior vena cava, and circumcaval anomalies of the left renal vein and ureter. Clinical significance is discussed for some anomalies.
This document provides information on the demonstration of peripheral and central line insertion. It begins by defining a peripheral venous line as a catheter placed in a peripheral vein for intravenous therapy. It then discusses the steps for peripheral line insertion and possible complications. The document next defines central line catheterization as a catheter placed in the thoracic veins or heart. It discusses the indications, sites of insertion, requirements, procedure using the Seldinger technique, and complications of central line insertion. Finally, it covers peripherally inserted central catheters as an alternative to other central lines.
The document discusses Nutcracker syndrome, which is caused by compression of the left renal vein between the abdominal aorta and superior mesenteric artery. It can cause hematuria, anemia, abdominal or pelvic pain. Diagnosis involves imaging tests like ultrasound, MRI, CT. Treatment options include analgesics, transposition surgery of the renal vein or superior mesenteric artery, stent placement, or nephrectomy in severe cases. Complications may include renal vein thrombosis. Nutcracker syndrome is underdiagnosed but should be considered in patients with left flank pain and hematuria or pelvic congestion.
1) Cerebrovascular malformations are classified based on their histopathologic features, including arteriovenous malformations (AVMs), venous angiomas, cavernous malformations, and capillary telangiectasias.
2) AVMs are vascular abnormalities consisting of direct connections between arteries and veins without an intervening capillary bed. They typically present with hemorrhage, seizures, or focal neurological deficits.
3) Treatment options for AVMs include observation, endovascular surgery, stereotactic radiosurgery, and microsurgery, with the appropriate treatment depending on factors like the AVM's size, location, and whether it has already hemorrhaged.
The document discusses cerebrovascular anomalies or malformations, which are conditions characterized by malformed blood vessels that can lead to hemorrhages, stroke, blood clots, and other complications. It covers the classification, epidemiology, clinical presentation, investigations, management, and treatment of various types of cerebrovascular anomalies, including arteriovenous malformations (AVMs), venous angiomas, and cavernous malformations. It also presents a case study example of a patient who experienced bleeding from a left parietal AVM and was treated surgically.
This document describes the anatomical boundaries of the thoracic cavity in the human body. The anterior boundary is the sternum and front surfaces of the trachea and heart. The middle boundary is the front of the trachea and back of the heart. The posterior boundary is a vertical line 1 cm behind the front surfaces of the thoracic vertebrae at the costovertebral junctions.
This document discusses a case report of a rare type of synovial sarcoma found in the hip joint of a patient. Synovial sarcoma is a type of soft tissue sarcoma that usually occurs in the arms, legs, or torso. It is uncommon to find synovial sarcoma in the joints. In this case, imaging such as MRI revealed a mass in the hip joint that had characteristics matching synovial sarcoma, such as varying intensity and the presence of necrosis. The patient underwent surgery to remove the tumor from the hip joint.
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Similar to ANATOMY EMBRYOLOGY AND IMAGING OF SVC.pptx
This document discusses testicular varicoceles, which are abnormal dilations of the veins within the pampiniform plexus that surrounds the testicles. Varicoceles are found in approximately 15% of men and can cause scrotal pain or swelling. Ultrasound is the most common imaging method used to diagnose varicoceles by identifying dilated veins in the pampiniform plexus that enlarge further with maneuvers like Valsalva. Treatment options include percutaneous embolization to occlude the spermatic vein by catheterization or surgical ligation of the vein through sub-inguinal, inguinal, or retroperitoneal approaches.
Anatomy and imaging of coronary artery disease withSarbesh Tiwari
1) Coronary CT angiography (CCTA) uses computed tomography to non-invasively image the coronary arteries. It provides high quality images of the coronary arteries and their branches.
2) CCTA is performed using either electron-beam CT or multi-detector row CT (MDCT). MDCT is now more commonly used due to its wider availability and lower cost. The latest generation 64-detector MDCT allows for very high resolution imaging.
3) CCTA requires careful preparation of the patient including medication to control heart rate and dilation of the coronary arteries. The scan itself involves ECG gating to image the heart during diastasis and injection of iodinated contrast to outline the coronary
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
This document discusses various types of vascular malformations of the brain. It describes arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), developmental venous anomalies (DVAs), cavernous malformations, and capillary telangiectasias. It provides details on imaging with angiography, CT, and MRI to identify these conditions. It also discusses treatments and classifications like the Borden system for DAVFs. Common locations are the transverse/sigmoid sinus for DAVFs and presentation can include pulsatile tinnitus, cranial nerve palsies, and hemorrhage.
Digital Subtraction Neuroangiography: What a Resident Should Know Dr. Shahnawaz Alam
This document provides an overview of digital subtraction neuroangiography for residents. It begins with an introduction to the principles and importance of neuroangiography. It then provides detailed descriptions of normal neurovascular anatomy and angiographic views of the extracranial carotid system, anterior and posterior circulations. It discusses indications, contraindications, patient preparation, technique, complications and case examples to illustrate pathologies. The goal is to equip residents with the basic knowledge to interpret images and safely perform neuroangiography.
This document discusses ventricular septal defects (VSDs), including their anatomy, types, clinical presentation, diagnostic workup, and management. The key points are:
1. VSDs allow blood to pass abnormal from the left to the right ventricle. The patient presented has symptoms of a long-standing moderate VSD.
2. Echocardiography is the primary imaging modality used to characterize VSD location, size, complications like pulmonary hypertension.
3. Treatment indications for VSDs include the presence of heart failure symptoms or pulmonary hypertension. Surgical closure or catheter device closure are options.
This document discusses Superior Vena Cava Syndrome (SVCS), which is caused by obstruction of the Superior Vena Cava (SVC). Malignancies are the most common cause, especially lung cancers like non-small cell lung cancer and small cell lung cancer. Symptoms range from mild edema to life-threatening signs. Diagnosis involves imaging like CT or MRI venography. Treatment depends on the severity and cause of SVCS, but may include steroids, endovascular stenting, chemotherapy, and/or radiotherapy. The goal is prompt symptom relief while determining the best long-term management based on the underlying condition.
Central venous access devices such as nontunneled central venous catheters and peripherally inserted central catheters can be placed under imaging guidance more safely than with external landmarks alone. Nontunneled catheters are commonly placed at the bedside using local anesthesia for temporary access when patients are too ill to transport. They provide advantages over tunneled catheters in that they do not require strict coagulation parameter adherence and can be easily removed. Proper placement of catheter tips is important to avoid complications and the superior vena cava-right atrial junction is the ideal target location.
Stereotactic radiosurgery in arterio venous malformationsumesh V
Stereotactic radiosurgery (SRS) is an effective treatment for arteriovenous malformations (AVMs). SRS precisely delivers high doses of radiation to the AVM nidus, resulting in progressive occlusion of vessels within 1-3 years. Obliteration rates after SRS range from 35-92%, with higher rates for smaller AVMs receiving higher radiation doses. Careful targeting of the AVM nidus using fusion of imaging modalities is important for treatment planning. Long-term follow up with MRI is needed to monitor for obliteration and potential radiation-related effects.
This document discusses the use of cardiac CT (CCT) for evaluating non-coronary cardiac conditions. It describes how CCT can assess myocardial diseases like dilated cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia. It also discusses how CCT evaluates pericardial diseases, valvular heart disease, cardiac masses, and congenital heart defects. CCT provides high resolution images of the heart and surrounding structures and can detect abnormalities in cardiac function, morphology, and tissue characteristics.
Cardiovascular CT is a valuable tool for evaluating congenital heart disease in children. It provides high spatial and temporal resolution to depict complex anatomy. Key applications include assessing pulmonary blood flow in pulmonary atresia, vascular rings prior to surgery, coronary artery anomalies, and postoperative complications. Careful patient preparation and protocols are needed given pediatric concerns. CT enables simultaneous evaluation of vascular structures, airways, and cardiac function to comprehensively evaluate complex congenital heart disease.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It provides information needed for coronary interventions. The procedure involves accessing the femoral or radial artery and advancing a catheter into the heart to inject contrast dye and image the arteries. It can detect blockages but has limitations like vessel overlap that may obscure lesions. Complications are rare but can include artery damage, embolism, or arrhythmias.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
Segmental approach and evaluation of cardiac morphologyNizam Uddin
This document discusses the segmental approach to evaluating cardiac morphology in congenital heart disease. It describes the three major cardiac segments - atria, ventricles, and great arteries - and how any combination of anomalies in these segments can occur. It emphasizes using a step-by-step approach to characterize each segment anatomically, describe the connections between segments, and identify any associated anomalies. MRI can help clarify complex intracardiac anatomy, characterize atrial and ventricular septal defects, and evaluate postoperative patients - complementing echocardiography in the evaluation, diagnosis and management of congenital heart disease.
Normal anatomy and congenital anomalies of vena cavaeGobardhan Thapa
This document discusses the normal anatomy and common congenital anomalies of the superior and inferior vena cavae. It begins with an overview of the embryological development of the vena cavae. It then describes the normal anatomy of the superior and inferior vena cavae and their major tributaries. Common congenital anomalies are then outlined, including double superior vena cavae, left-sided superior vena cava, left inferior vena cava, double inferior vena cava, azygos continuation of the inferior vena cava, and circumcaval anomalies of the left renal vein and ureter. Clinical significance is discussed for some anomalies.
This document provides information on the demonstration of peripheral and central line insertion. It begins by defining a peripheral venous line as a catheter placed in a peripheral vein for intravenous therapy. It then discusses the steps for peripheral line insertion and possible complications. The document next defines central line catheterization as a catheter placed in the thoracic veins or heart. It discusses the indications, sites of insertion, requirements, procedure using the Seldinger technique, and complications of central line insertion. Finally, it covers peripherally inserted central catheters as an alternative to other central lines.
The document discusses Nutcracker syndrome, which is caused by compression of the left renal vein between the abdominal aorta and superior mesenteric artery. It can cause hematuria, anemia, abdominal or pelvic pain. Diagnosis involves imaging tests like ultrasound, MRI, CT. Treatment options include analgesics, transposition surgery of the renal vein or superior mesenteric artery, stent placement, or nephrectomy in severe cases. Complications may include renal vein thrombosis. Nutcracker syndrome is underdiagnosed but should be considered in patients with left flank pain and hematuria or pelvic congestion.
1) Cerebrovascular malformations are classified based on their histopathologic features, including arteriovenous malformations (AVMs), venous angiomas, cavernous malformations, and capillary telangiectasias.
2) AVMs are vascular abnormalities consisting of direct connections between arteries and veins without an intervening capillary bed. They typically present with hemorrhage, seizures, or focal neurological deficits.
3) Treatment options for AVMs include observation, endovascular surgery, stereotactic radiosurgery, and microsurgery, with the appropriate treatment depending on factors like the AVM's size, location, and whether it has already hemorrhaged.
The document discusses cerebrovascular anomalies or malformations, which are conditions characterized by malformed blood vessels that can lead to hemorrhages, stroke, blood clots, and other complications. It covers the classification, epidemiology, clinical presentation, investigations, management, and treatment of various types of cerebrovascular anomalies, including arteriovenous malformations (AVMs), venous angiomas, and cavernous malformations. It also presents a case study example of a patient who experienced bleeding from a left parietal AVM and was treated surgically.
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This document describes the anatomical boundaries of the thoracic cavity in the human body. The anterior boundary is the sternum and front surfaces of the trachea and heart. The middle boundary is the front of the trachea and back of the heart. The posterior boundary is a vertical line 1 cm behind the front surfaces of the thoracic vertebrae at the costovertebral junctions.
This document discusses a case report of a rare type of synovial sarcoma found in the hip joint of a patient. Synovial sarcoma is a type of soft tissue sarcoma that usually occurs in the arms, legs, or torso. It is uncommon to find synovial sarcoma in the joints. In this case, imaging such as MRI revealed a mass in the hip joint that had characteristics matching synovial sarcoma, such as varying intensity and the presence of necrosis. The patient underwent surgery to remove the tumor from the hip joint.
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This document discusses the anatomy, embryology, and imaging of the superior vena cava (SVC). It begins with an introduction to the SVC's role as the largest central vein in the mediastinum. Imaging plays an important role in identifying congenital variants and pathologies. The document then covers the embryological development of the SVC, its normal anatomy and tributaries, and techniques for imaging it with various modalities like CT, MR, and venography. It discusses congenital variants like persistent left SVC and aneurysms. It also reviews acquired conditions like strictures, thrombus, and various tumors that can affect the SVC.
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The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
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আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
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What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
2. INTRODUCTION
• The superior vena cava (SVC) is the largest central systemic vein in the
mediastinum.
• Imaging (ie, radiography, computed tomography [CT], magnetic resonance [MR]
venography, and conventional venography) plays an important role in identifying
congenital variants and pathologic conditions that affect the SVC.
• Knowledge of the basic embryology and anatomy of the SVC and techniques for
CT, MR imaging, and conventional venography are IMPORTANT to accurately
diagnosis and clinical decision making.
3. • Congenital anomalies such as Persistent left SVC, Partial anomalous
pulmonary venous return, and Aneurysm are asymptomatic and may be
discovered incidentally in patients undergoing imaging evaluation for
associated cardiac abnormalities or other indication.
• Familiarity with congenital abnormalities is important to avoid image
misinterpretation.
5. COURSE AND DIAMETER
• The SVC is formed by the confluence of the right and left brachiocephalic
veins. It courses along the right middle mediastinum, with the trachea and
ascending aorta on its left, and drains into the right atrium.
• Extent - From First intercostal space to Right 2nd intercostal space
• The mean length of the SVC is 7.1 cm ± 1.4, and its maximum diameter in
adults is 2.1 cm ± 0.7.
• An SVC area of less than 1.07 cm2 is an accurate threshold for SVC
obstruction or compression.
6. • The azygos vein is a major tributary that travels along the right anterior
borders of the thoracic vertebrae up to the level of the carina and then
traverses the middle mediastinum, arching over the right
tracheobronchial angle to drain posteriorly into the distal SVC.
• In case of SVC obstruction the veins getting prominent are :
Azygos–hemiazygos–accessory hemiazygos system,
Mediastinal venous plexus,
Diaphragmatic venous plexus
Lateral thoracic and superficial thoracoabdominal venous plexus,
Abdominal venous collaterals
7. Branches and Tributaries of the Superior Vena Cava
□ Left brachiocephalic (innominate) vein
• Left subclavian vein
• Left internal jugular vein
• Left superior intercostal vein
□ Right brachiocephalic (innominate) vein
• Right subclavian vein
• Right internal jugular vein
□ Azygos vein
• Hemiazygos vein
• Accessory hemiazygos vein
8.
9. EMBRYOLOGY
• THREE basic venous system
of human foetal circulation
1.Vitelline veins
2.Umbilical veins
3.Somatic (Cardinal veins)
13. IMAGING
• Imaging plays an important role in diagnosis and management of
various conditions that affect the SVC.
• Doppler ultrasonographic (US) evaluation of the SVC is limited
because of the poor acoustic window.
• Direct visualization of the SVC is better obtained at computed
tomography (CT) or magnetic resonance (MR) imaging.
• Contrast agent–enhanced venography with use of digital subtraction
is reserved for interventional procedures and when CT and MR
imaging findings are nondiagnostic
14. On Chest Radiography
• SVC forms an interface along the upper
right mediastinal border that fades above
the medial end of the clavicle
• Frontal and, when obtained, lateral
radiographs are the primary imaging tools
used to evaluate normal positioning of
central venous catheters (CVCs) and
peripherally inserted central catheters
(PICCs).
15. On Computed Tomography
Nonenhanced CT—
• Nonenhanced CT images can demonstrate SVC duplication, narrowing,
and enlargement.
• It can also show CVC (Central venous catheter) position.
• It can be used to visualize calcifications along the SVC that could be
caused by calcified thrombi, fibrin sheaths, or retained catheter or
implantable cardioverter-defibrillator lead fragments.
16. Contrast-enhanced CT.—
• The SVC can be studied during routine contrast-enhanced chest CT.
• Routine contrast-enhanced CT of the chest, performed 60–75 seconds after
injecting contrast agent into a peripheral vein, achieves excellent uniform
enhancement of the SVC.
• Difficulties in CT imaging might be faced due to
• 1. Streak artifacts due to dense contrast media, which can be minimized by
diluted contrast and adjusting the settings according to the viewer.
• 2. Mixing artifacts due to nonenhanced blood from contralateral veins and the
azygos vein, which can mimic a thrombus.
18. • Routine Protocol:
• Contrast volume and concentration :
Weight based (1 mL/kg; iodine concentration, 350 mg/mL)
• Flow rate: 2.5- 3 mL/sec
• Acquisition delay :40–60 sec
• Contrast agent volume overestimation in obese patients; volume
adjusted to body surface area is more appropriate
19. Magnetic Resonance Venography
Conventional non contrast MR imaging is done
usually to:
Locate the location and extent of strictures
Collateral pathways
Endoluminal thrombus,
Tumor proliferation
20. • Contrast-enhanced MR venography is a particularly well suited technique
for this anatomic region and can be especially advantageous in patients
with impaired renal function, who have a dialysis shunt, fistula or long time
central catheter placement.
• The SVC can also be evaluated by using a blood pool–specific contrast agent
(Gadopentetate Dimeglumine 469mg/ml )
• In our institute we follow the protocol including the TRICKS sequence
• TRICKS sequence ( Time Resolved Imaging of Contrast KineticS) which
obtains series of images displaying passage of contrast bolus.
21. • We use the antecubital vein and pass 15
ml of contrast followed by 15 ml of Saline
• The acquisition is done at around 40 sec
for the venography.
• MR venography has been shown to be
equally sensitive and specific compared
with conventional venography to evaluate
central venous obstruction
22. Doppler Ultrasound and
Echocardiography
Direct visualization of the SVC at
Doppler US is challenging.
A limited role for Doppler US in
evaluation of the proximal SVC with
use of suprasternal and right
supraclavicular window settings
23. Digital Subtraction Imaging Of SVC
• Superior venacavography is performed with simultaneous bilateral injection
of 25 mL of a nonionic contrast medium into the basilic, cephalic, or
antecubital vein through an 18- to 20-gauge peripherally inserted
intravenous catheter.
• Digital subtraction is usually required to adequately visualize the SVC.
Nonenhanced inflow from other central veins should not be mistaken for
thrombus or other filling defects.
• One of the major advantages of conventional arm venography is an ability
to proceed directly to an intervention if an abnormality amenable to
treatment is found
26. Persistent Left SVC
• Persistent left SVC is the most common
congenital thoracic venous anomaly.
• In the midportion, the vessel lies anterior
to the left hilum and then traverses along
the ligament of Marshall to drain into the
right atrium via a dilated coronary sinus .
• Persistent left SVC should be suspected
when a dilated coronary sinus is seen at
cross-sectional imaging
27. PAPVR(Partial anomalous pulmonary venous return
• One or more pulmonary veins drain into the systemic venous system or
right atrium rather than the left atrium.
• Right upper lobe PAPVR is a subset of this condition in which the right
upper lobe pulmonary vein drains directly into the SVC.
• Pediatric studies suggest a high association of right upper lobe PAPVR
with sinus venosus atrial septal defect in 80%–90% of patients whereas a
recent study in adults showed a moderate association of 47%
28.
29. SVC ANEURYSM
• SVC aneurysm is extremely rare and is
asymptomatic that may be found
incidentally at imaging performed for
other indications.
• Causes include congenital weakness in
the SVC wall or absence of the
longitudinal muscle layer in the tunica
adventitia .
• There are no strict size criteria for
diagnosis, and saccular and fusiform
types have been described.
30. Acquired Abnormalities
• Stricture
• Fibrin sheath
• Thrombus
• Trauma
• Primary neoplasms
1. SVC Lipoma or Extension of Lipomatous Hypertrophy of the Interatrial
Septum
2. Primary SVC Sarcoma or Leiomyosarcoma
31. Stricture
• Stricture can be due to intrinsic or extrinsic causes
Intrinsic causes:
1. Long standing Central venous catheters
2. Transvenous pacemakers
3. Postoperative or post-radiation effects.
Extrinsic causes:
1. Malignancies (Most common)
2. Compression from mediastinal masses,
3. Fibrosing mediastinitis.
33. FIBRIN SHEATH
• A fibrin sheath is a heterogeneous
matrix of cells and debris containing
variable amounts of thrombus,
endothelial cells, and collagen that
forms around most hemodialysis
catheters by the end of the 1st week of
placement
• On Xray it can be seen as linear,
irregularly shaped, calcified or
noncalcified, structure within a central
vein
34. THROMBUS
• 2 types , either bland or tumour thrombus.
• Infection and thrombosis are the most common complications of long-
standing CVCs or implantable central venous devices.
• On Non enhanced CT – Difficult to identify.
• On Contrast enhanced CT- central or eccentric non enhancing filling defect
in the SVC, usually in relation to a CVC or pacer lead.
• Performing nonenhanced and gadolinium-enhanced MR imaging helps in
identifying bland thrombus. As opposed to bland thrombus, tumor
thrombus often shows heterogeneous contrast enhancement at MR
imaging
• Tumor thrombus is generally larger and lobulated and is associated with an
adjacent mass or wall invasion
35.
36. TRAUMA
• RARE
• Mostly due to penetrating trauma
• It is usually seen at the junction of the
SVC and right atrium because of the
relative mobility at this hinge point and
results in a contained mediastinal
hematoma
• Hemopericardium with pericardial
tamponade physiology may be seen.
38. To Summarise. . .
• SVC is an important and often ignored structure.
• This is best visualized on contrast enhanced CT .
• There are not many pathologies associated with SVC
but important one is the Persistent Left SVC which is an
incidental finding while doing post CVC X-Ray.
THANK YOU
39. References
• Sonavane SK, Milner DM, Singh SP, Abdel Aal AK, Shahir KS, Chaturvedi A.
Comprehensive Imaging Review of the Superior Vena Cava. Radiographics. 2015
Nov-Dec;35(7):1873-92.doi: 10.1148/rg.2015150056. Epub 2015 Oct 9. PMID:
26452112.
• Liu, Haitao & Li, Yahua & Wang, Yang & Yan, Lei & Zhou, Pengli & Han, Xinwei.
(2021). Percutaneous transluminal stenting for superior vena cava syndrome caused
by malignant tumors: a single-center retrospective study. Journal of Cardiothoracic
Surgery. 16. 10.1186/s13019-021-01418-w.
• Netter Atlas of Human Anatomy 7th Edition.
• Inderbir Singh’s Human Embryology 11th Edition.
Editor's Notes
By using data from electrocardiography (ECG)–gated CT angiography, Lin et al (3) have demonstrated that the SVC is often irregular in shape on cross-sectional images. They have suggested a normal range for the major axis (1.5–2.8 cm) and minor axis (1–2.4 cm)
Frontal chest radiograph in a 41-year-old man shows the normal SVC interface (arrowheads) and the terminal portion of the azygos vein (arrow).
Figure 10. SVC thrombus at nonenhanced MR imaging. A 47-year-old woman with end-stage renal disease and clinical concern for central venous stenosis underwent nonenhanced ECG- and respiratory-gated 3D SSFP MR imaging. Coronal MR image shows a CVC (arrows) in the SVC, with an eccentric low-signal-intensity filling defect (arrowhead) consistent with thrombus in the cranial portion of the SVC
Routine Protocols For MR venography
SVC stenosis at contrast-enhanced MR venography. A 58-year-old man underwent peripheral runoff contrast-enhanced MR venography with blood pool– specific contrast agent (gadofosveset trisodium [Ablavar; Lantheus Medical Imaging, North Billerica, Mass]). Coronal steady-state MR venogram obtained at 3 minutes shows severe stenosis of the upper SVC (arrow)
A case of superior vena cava syndrome with restenosis after stenting. a. DSA image showing obvious compression and stenosis of the superior vena cava. b. Angiographic image 16 months after stent implantation showing a filling defect in the superior vena cava stent. c. Placement of a longer stent in the original stent
A dilated coronary sinus, especially with an absent right SVC, can cause stretching of the arteriovenous node and the bundle of His; cardiac arrhythmias such as atrial and ventricular fibrillation have been reported
) Axial contrastenhanced CT images show the left SVC (arrowhead in a–c) as follows: coursing in a craniocaudal direction lateral to the aortic arch (a), anterior to the left pulmonary artery (arrow in b), in the left atrioventricular groove along the ligament of Marshall (c), and draining into the coronary sinus (arrow in d). (e) Oblique sagittal contrastenhanced 3D volume-rendered CT image shows the course of the left SVC (arrowheads) relative to the left pulmonary artery (thick arrow) and coronary sinus (thin arrow).
PAPVR detected at CT angiography in a 39-year-old man who underwent a workup for pulmonary hypertension. Axial (a) and oblique sagittal (b) images show a right upper lobe PAPVR draining at the junction of the SVC and right atrium (RA) (arrowhead), with communication between the right and left atrium (LA) at the same level (arrow). The findings are consistent with sinus venosus atrial septal defect.
SVC aneurysm in a 52-yearold woman with no signs of cardiac failure or central venous obstruction. Coronal contrast-enhanced reformatted chest CT image shows fusiform aneurysmal dilatation of the upper mid SVC (arrow) measuring 3.0 cm in diameter, with a normalcaliber lower SVC (arrowhead).
The tumors most commonly responsible for compression or invasion of the SVC are small cell and non–small cell lung cancers, lymphoma, metastatic lymphadenopathy from intrathoracic and extrathoracic malignancies, and tracheal malignancies (40,41)
1.Intrinsic SVC stricture in a 55-year-old woman. Coronal (a) and axial (b) contrast-enhanced maximum intensity projection chest CT images show a CVC (placed via the right internal jugular vein) causing severe wall thickening, stricture, and complete occlusion of the proximal SVC (arrow in a). Multiple chest wall and mediastinal venous collaterals (arrowhead in b) are seen draining through the hemiazygos (HAZ) and azygos (AZ) venous systems.
2.SVC stricture caused by extrinsic compression. (a) Axial contrast-enhanced chest CT image in a 42-year-old woman shows metastatic lymphadenopathy (arrow) from a germ cell tumor, a finding causing moderate compression of the SVC (arrowhead). (b) Axial contrast-enhanced chest CT image in a 72-year-old man shows an ascending aortic aneurysm (arrow) from a Stanford type A dissection, a finding causing severe compression of the SVC (arrowhead)
1. Axial contrast-enhanced chest CT image shows a lung mass (arrows) invading the mediastinum, with a large intraluminal enhancing tumor thrombus in the SVC (arrowhead) causing severe luminal narrowing. Contrast agent is seen in the patent portion of the SVC.
Axial contrastenhanced chest CT image in a 58-year-man after a motor vehicle collision shows a contained mediastinal hematoma (arrowheads), with a few foci of active contrast agent extravasation (thin arrow) seen anterior to the distal SVC (thick arrow)..
show an area of fat attenuation (arrow) causing moderate extrinsic compression and narrowing of the caudal SVC (arrowhead), a finding consistent with SVC lipoma. It is smooth, minimal enhancement.
Axial contrast enhanced chest CT image shows an intraluminal, lobulated, enhancing filling defect in the mid distal SVC causing moderate luminal dilatation (arrow). Aggressive , smooth or lobulated expand the vessel.