Two cases of vertebral perfusion disturbances in computer tomography imitating metastatic lesions in the course of superior vena cava thrombosis

Abstract

Skeletal metastases are frequently observed in various malignancies. In some cases, they are asymptomatic and can be found incidentally in various imaging methods in patients without known malignant tumors. In this case study 2 cases of vertebral perfusion disturbances are presented that imitate vertebral metastatic lesions in computer tomography in the course of superior vena cava thrombosis. The first patient was referred to our clinic for chest and abdominal computer tomography (CT) for staging due to a known tumor in the anterior mediastinum. The second patient was referred for chest CT due to swelling in the upper extremity and neck, with the suspected diagnosis of a tumor or pulmonary embolism. In both cases, CT scans showed metastases suspected lesions in the upper thoracic vertebral bodies. In both cases, additionally, the thrombosis of superior vena cava (SVC) and vena brachiocephalica was confirmed (in the first case due to tumor compression in the upper mediastinum, in the second case due to the presence of pacemaker leads). In control CT scans after anticoagulation treatment, there were no suspected lesions in the vertebral bodies, which confirmed the diagnosis of vertebral perfusion disturbances in the course of SVC thrombosis in both patients. In conclusion, in rare cases of metastases suspected lesions of thoracic vertebral bodies in contrast-enhanced computer tomography among patients with a diagnosis of superior vena cava thrombosis vertebral perfusion disturbances should be included in differential diagnosis protocol.

Keywords: Collateral circulation; Neoplasm metastasis; Superior vena cava syndrome; Tomography; Venous thrombosis.

Fig. 1

(A) CT images of thoracic vertebral bones (axial and sagittal) – diffuse hyperdense lesions in Th2-Th6 (arrows) initially evaluated as highly suspected of metastases. Congestion in the paravertebral veins (arrowheads). Additional dense soft-tissue mass of about 4 × 6 × 12 cm in size, located in the upper mediastinum ventrally to the heart with filling of the entire retrosternal space and extending to the neck through the thoracic aperture (black arrows with white contours). (B) CT images of upper thoracic vertebral bones obtained during the biopsy of tumor in the anterior mediastinum (axial and sagittal). Black arrows with white contours show soft-tissue mass located in the upper mediastinum. No suspected lesions in the vertebral bodies. (C) MRI images of thoracic vertebral column, T2-STIR sagittal (left) and T1 sagittal (right) – T2-STIR slightly signal increases and T1 slightly signal reduction in Th1-Th6. (D) Control CT 2 weeks after initial CT. Non-contrast enhanced images of thoracic vertebral bones (axial and sagittal). There were no hyperdensity in the vertebral bodies.) Control CT 2 weeks after initial CT. Contrast enhanced images of thoracic vertebral bones (axial and sagittal). Images revealed diffuse hyperdense lesions in the upper thoracic vertebral bodies (arrows) as well as congestion in the paravertebral veins (arrowheads).

Fig. 1

(A) CT images of thoracic vertebral bones (axial and sagittal) – diffuse hyperdense lesions in Th2-Th6 (arrows) initially evaluated as highly suspected of metastases. Congestion in the paravertebral veins (arrowheads). Additional dense soft-tissue mass of about 4 × 6 × 12 cm in size, located in the upper mediastinum ventrally to the heart with filling of the entire retrosternal space and extending to the neck through the thoracic aperture (black arrows with white contours). (B) CT images of upper thoracic vertebral bones obtained during the biopsy of tumor in the anterior mediastinum (axial and sagittal). Black arrows with white contours show soft-tissue mass located in the upper mediastinum. No suspected lesions in the vertebral bodies. (C) MRI images of thoracic vertebral column, T2-STIR sagittal (left) and T1 sagittal (right) – T2-STIR slightly signal increases and T1 slightly signal reduction in Th1-Th6. (D) Control CT 2 weeks after initial CT. Non-contrast enhanced images of thoracic vertebral bones (axial and sagittal). There were no hyperdensity in the vertebral bodies.) Control CT 2 weeks after initial CT. Contrast enhanced images of thoracic vertebral bones (axial and sagittal). Images revealed diffuse hyperdense lesions in the upper thoracic vertebral bodies (arrows) as well as congestion in the paravertebral veins (arrowheads).

Fig. 2

(A) CT images of thoracic vertebral bones (axial and sagittal) – hyperdense lesions in Th2 (arrows) initially evaluated as highly suspected of metastases. (B) CT images of thoracic vertebral bones (axial and sagittal) 4 months later – diffuse hyperdense lesions in Th2-Th6 (arrows) evaluated as highly suspected of metastases.