Imaging of the Superior Vena Cava

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Procedures: 2.00
Neck and Chest: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Body: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Abdominal Section: 2.00

Outline

1. Introduction
2. Embryology
3. Anatomy
4. Imaging Modalities
   1. Chest Radiography
   2. Computed Tomography
      1. Nonenhanced CT
      2. Contrast-enhanced CT
   3. MR Venography
      1. Conventional Venography
   4. Doppler US and Echocardiography
5. Congenital Variants
   1. Persistent Left SVC
   2. Right Upper Lobe Partial Anomalous Pulmonary Venous Return
   3. SVC Aneurysm
6. Acquired Abnormalities
   1. Stricture
   2. Fibrin Sheath
   3. Thrombus
   4. Primary Neoplasms
      1. SVC Lipoma or Extension of Lipomatous Hypertrophy of the Interarterial Speptum
      2. Primary SVC Sarcoma or Leiomyosarcoma
   5. Trauma
7. SVC Interventional Procedures
   1. Fibrin Sheath Management
   2. Venous Angioplasty and Stent Placement
   3. SVC Filter Placement
8. Conclusion

Objectives

Upon completion of this course, students will:

1. state the function of the SVC
2. describe embryologic development of the SVC
3. know the veins that form the SVC
4. explain where the SVC enters the heart
5. describe the length of SVC
6. indicate SVC abnormalities on chest radiography
7. explain the location for CVCs within the SVC
8. state the benefit of nonenhanced CT imaging in regard to the SVC
9. explain how to reduce streak artifact on contrast-enhanced CT
10. describe MR venography
11. list the advantages of conventional venography
12. list veins used for superior venacavography
13. describe why direct visualization of the SVC at Doppler US is challenging
14. state the most common congenital thoracic venous anomaly
15. state the prevalence of persistent left SVC in the general population
16. state the cause of persistent left SVC
17. understand imaging indications to diagnose persistent left SVC
18. explain difficulties in pacemaker placement with regard to persistent left SVC
19. describe PAPVR
20. describe why sinus venosus atrial septal defect is difficult to detect at transthoracic echocardiography
21. list the causes of SVC aneurysm
22. differentiate between saccular and fusiform SVC aneurysms
23. differentiate between intrinsic and extrinsic factors for SVC strictures
24. state the characteristics of SVC syndrome
25. list the extrinsic causes of SVC strictures
26. state the most common cause of SVC obstruction
27. explain how fibrin sheath is confirmed
28. state the most common complications of long-standing CVCs or implantable central venous devices
29. list secondary complications of SVC thrombosis
30. explain where thoracic leiomyosarcoms metastasize
31. describe how the SVC is affected by trauma
32. describe care given for iatrogenic rupture of the SVC during interventional procedures
33. state the six-week patency rate for the internal snare maneuver
34. state the mainstay treatment for benign SVC stenosis or occlusion
35. state the percentage of cases where pulmonary embolism complicates upper extremity deep venous thrombosis