Dynamic ventilation and perfusion images in multiple projections
View main image(vq) in a separate image viewer
View second image(vq). Spot images of the brain and abdomen
View third image(mc). Picture of the patient's neck prior to bending over
View fourth image(mc). Picture of the patient's neck after she bent over with her head below her heart for a few seconds. Image exposure is unchanged relative to the previous image.
Full history/Diagnosis is available below
Upon further questioning, the patient has been having difficulty with nausea and vomiting. When she bends over to vomit, she has noted persistent swelling in her neck. This was demonstrated to us in the Nuclear Medicine Department where she had persistent jugulo-venous distention as well as facial and neck plethora after bending over. In addition, she has a left subclavian porta catheter in place for administration of Cytoxan for lupus nephritis.
With contrast injection, the left subclavian vein is somewhat small and contains a small linear filling defect. The innominate vein at its junction with the left subclavian vein is normal in caliber but then tapers down centrally before entering the superior vena cava. The superior vena cava appears normal in caliber and no thrombus is seen.
Multiple collateral vessels are seen in and around the left shoulder girdle with collaterals extending across the lower neck and perivertebral region to bypass the narrowing.
OPINION: 1. Chronic thrombi and narrowing involving the left subclavian vein and central left brachiocephalic vein as described above. Multiple collateral vessels are seen entering the left shoulder and chest and bypass these areas.
2. Normal appearing superior vena cava.
View followup image(an). Left upper extremity venogram.
References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Other(Artifact))
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