2024 Friday Quiz 30 Answer | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Coronal (Image 1) and axial (Images 2 and 3) contrast-enhanced CT reveal the 'hot quadrate' sign (arrow) due to superior vena cava occlusion (arrowhead). In this patient, the thrombus extends into the right atrium (arrowhead, image 3). The hot quadrate sign occurs due to collateral venous flow around the obstructed superior vena cava. In this setting, contrast passes from the upper extremity to the inferior vena cava via collateral veins such as the internal thoracic, superior and inferior epigastric, and paraumbilical veins.

Similar cases

\n\nCoronal (image 1) and axial (image 2) contrast enhanced CT obtained in a child with neuroblastoma shows a large left neuroblastoma (arrowhead). The tumor crosses midline, partially encases the aorta, and extends into the inferior vena cava (arrow). There is also diffuse involvement of the pancreas (dashed arrow). Vascular invasion in patients with neuroblastoma is incredibly uncommon. More typically, neuroblastoma uplifts, displaces, and encases vessels. #TummyTuesday #AbdomenTuesday

\n\nAxial T2 weighted (image 1), coronal T2 weighted (image 2), axial T1 post contrast in the portal venous phase of imaging (image 3) and coronal postcontrast in the hepatobiliary phase of imaging (image 4) show the large mass (arrow) of the right hepatic lobe. In addition, there is thrombosis of the inferior vena cava (arrowhead) and portal vein (more posterior arrow on image 3). Hepatoblastoma is the most common hepatic malignancy of childhood. It is associated with prematurity and syndrome such as Beckwith Weidman syndrome or familial adenomatous polyposis. Hepatoblastoma is staged using the pretext system.

\n\nCoronal (images 1, 2, and 3) and axial (image 4) contrast-enhanced CT images show thrombosis of the right gonadal vein (arrow) with the thrombus extending into the inferior vena cava (arrowhead). Spontaneous thrombosis of the gonadal vein most commonly occurs in the postpartum state, with the right gonadal vein being affected more frequently.

\n\nAxial contrast-enhanced CT of the abdomen shows a rectangular area of increased early hepatic parenchymal enhancement (arrow) within segment IV of the liver. This finding is termed the hot quadrate sign and is a finding of superior vena cava obstruction. Small venous collateral vessels (arrowhead) are shunting blood between the superior vena cava and the left portal vein via internal mammary and paraumbilical veins. This finding is termed the hot quadrate sign and is a finding of superior vena cava obstruction. Coronal contrast-enhanced CT of the chest (image 2) shows lymphoma (arrow) causing obstruction of the superior vena cava (arrowhead).