54 year-old male patient with a history of mediastinal fibro | Figure 1

SIRRFS

Case Overview

54 year-old male patient with a history of mediastinal fibrosis complicated by SVC syndrome status-post SVC stent.

Patient presents with worsening right-sided chest tightness, increasing exertional and positional dyspnea when sleeping on his right side. What are the imaging findings/diagnosis on CT angiography of the chest? Comment below with your thoughts. The answer and intervention will be posted tomorrow!

Imaging Cases

Similar Cases

Case 1

Description: This is the CT image from my last post (with the chest X-ray too). Key findings were: small sternotomy wires for an adult, meaning they were from childhood surgery, right sided aortic arch and huge pulmonary arteries. This is #Tetralogy-of-Fallot corrected in childhood but with complication of pulmonary stenosis and #Regurgitation. 25% have a right sided arch.

Case 2

Description: 32 year-old male presents with dyspnea on exertion, facial swelling, flushing and weight gain. PA and lateral chest radiograph demonstrates widening of the superior mediastinum and coronal image demonstrates SVC obstruction/invasion secondary to paratracheal mass with coarse calcifications. Central venography demonstrates high-grade stenosis of the proximal SVC, at the level of the confluence. Kissing balloon angioplasty are performed. Post-angioplasty repeat venography demonstrates significant improvement in lumen caliber.

Case 3

Description: Attempted picc with svc located on left side of heart. Having trouble verifying.

Case 4

Description: Shortness of breath and right side chest pain.