Thoracic collateral venous channels: normal and pathologic CT findings

Opacification of thoracic collateral venous channels (CVC) on chest CT is considered a useful sign of superior vena cava (SVC) obstruction, although its lack of specificity has occasionally been emphasized. We compared the degree of opacification of six various thoracic CVC in a group of 36 patients with SVC syndrome and in a control group of 50 patients; a dynamic incremental CT technique with bolus injection was used. Opacification of at least one CVC is inaccurate for the diagnosis of SVC obstruction, with a false-positive and false-negative rate of 34 and 31%, respectively. Only the opacification of the subcutaneous anterior channel provides a good specificity (96%), significantly higher (p less than 0.05) than that observed for the posterior collateral channels. In patients in whom the clinical records and other direct CT signs of vena cava obstruction are doubtful or absent, opacification of a subcutaneous anterior channel on chest CT should lead to a suspicion of obstruction of the SVC and cavography should be performed.