Superior Vena Cava Occlusion by Cardiovascular Magnetic Resonance
A 30-year-old man was referred for cardiac and hepatic iron quantification by cardiovascular magnetic resonance. He was known to have β-thalassemia major and was heavily transfusion dependent, requiring intensive intravenous chelation therapy. However, after nonadherence to anticoagulation and parenteral therapy, his Portacath had thrombosed, necessitating removal.
Cardiovascular magnetic resonance revealed stable left ventricular function and stable but severe iron loading. However, initial views showed a dilated azygous venous system (the Figure, A) with, on black-blood imaging, venous dilatation of internal thoracic and cutaneous veins (the Figure, B). Venous angiography with bilateral antecubital injections (the Figure, C) confirmed complete superior vena cava occlusion with collateralized drainage to the inferior vena cava via these 3 routes, the cutaneous veins being visually prominent during Valsalva (the Figure, D). Superior vena cava venous stenting was considered. However, in view of the chronicity and length of the thrombosis, a conservative approach with lifelong anticoagulation was taken.
Iatrogenic superior vena cava occlusion from indwelling catheters is increasing. Anticoagulation should be considered in patients with long-term indwelling catheters,1 particularly in the presence of thrombotic risk factors, which may include active bone marrow and/or splenectomy.