Comprehensive Imaging Review of the Superior Vena Cava

• Published in: Radiographics Vol. 35; no. 7; pp. 1873 - 1892
• Main Authors: Sonavane, Sushilkumar K, Milner, Desmin M, Singh, Satinder P, Abdel Aal, Ahmed Kamel, Shahir, Kaushik S, Chaturvedi, Abhishek
• Format: Journal Article
• Language: English
• Published: United States 01-11-2015
• Subjects: Aneurysm - diagnostic imaging; Angioplasty, Balloon; Azygos Vein - anatomy & histology; Azygos Vein - diagnostic imaging; Brachiocephalic Veins - anatomy & histology; Brachiocephalic Veins - diagnostic imaging; Constriction, Pathologic; Contrast Media; Humans; Jugular Veins - anatomy & histology; Jugular Veins - diagnostic imaging; Magnetic Resonance Imaging; Phlebography - methods; Radiography, Interventional; Radiography, Thoracic - methods; Stents; Subclavian Vein - anatomy & histology; Subclavian Vein - diagnostic imaging; Tomography, X-Ray Computed - methods; Vascular Neoplasms - diagnostic imaging; Vena Cava Filters; Vena Cava, Superior - abnormalities; Vena Cava, Superior - anatomy & histology; Vena Cava, Superior - diagnostic imaging; Vena Cava, Superior - embryology; Venous Thrombosis - diagnostic imaging
• ISSN: 0271-5333; 1527-1323
• DOI: 10.1148/rg.2015150056

The superior vena cava (SVC) is the largest central systemic vein in the mediastinum. Imaging (ie, radiography, computed tomography [CT], magnetic resonance [MR] venography, and conventional venography) plays an important role in identifying congenital variants and pathologic conditions that affect the SVC. Knowledge of the basic embryology and anatomy of the SVC and techniques for CT, MR imaging, and conventional venography are pivotal to accurate diagnosis and clinical decision making. Congenital anomalies such as persistent left SVC, partial anomalous pulmonary venous return, and aneurysm are asymptomatic and may be discovered incidentally in patients undergoing imaging evaluation for associated cardiac abnormalities or other indications. Familiarity with congenital abnormalities is important to avoid image misinterpretation. Acquired abnormalities such as intrinsic and extrinsic strictures, fibrin sheath, thrombus, primary neoplasms, and trauma can produce mild narrowing to complete occlusion, the latter leading to SVC syndrome. Each imaging modality plays a role in evaluation of the SVC, helping to determine the site, extent, and cause of pathologic conditions and guide appropriate management. Commonly performed interventional procedures for fibrin sheath and benign and malignant strictures include low-dose thrombolytic infusion, fibrin sheath disruption, venous angioplasty, and stent placement.