Systemic-pulmonary venous shunt with SVC syndrome in a 58-year-old male is presented. Two months after resection of a right Pancoast tumor, SVC syndrome was noticed. RI angiography from the right antecubital vein demonstrated systemic-pulmonary venous shunt between the venous plexus of the right thoracic wall and right pulmonary veins. Nonselective PAG confirmed this phenomenon. Perfusion lung scan with 99mTc-macroaggregated albumin (MAA) from the right antecubital vein showed marked RI accumulation in the kidneys and brain, indicating right to left shunt. The ratio of extrapulmonary activity to whole body activity showing right to left shunt ratio of the right arm venous drainage was 54%. Perfusion lung scan by foot injection showed no activity in the kidneys and brain, thereby excluding intracardiac shunt.
Generally 4 collateral pathways have been described, 1) internal thoracic vein, 2) lateral thoracic vein, 3) azygos vein and 4) vertebral venous plexus. As a 5th pathway, systemic-pulmonary venous shunt must be considered in the case of pleural adhesion. Systemic-pulmonary venous shunt is rare and this case is the third case in the review of international and Japanese literature.
