Thoracic Park: cardiac MRI reveals massive thoracic varices as consequence of inferior vena cava ligation

A 71-year-old gentleman underwent a cardiac magnetic resonance (CMR) scan as part of a panel of investigations for unexplained breathlessness. CMR (Panels A–C) revealed remarkable collateral thoracic vasculature; with dilatation of the superior vena cava, extreme tortuosity and massive dilatation of the azygos and hemiazygos system with large intercostal varicose venous channels draining into the axillary veins. In addition, there was splenomegaly and elevation of the left hemidiaphragm. Splenic venous drainage was complex, via innumerable serpiginous veins anastomosing at the anterior abdominal wall into the systemic venous drainage.

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