A 52-year-old man with a stage IV lung cancer was admitted to our hospital for evaluation of progressive shortness of breath, mild neck swelling and sensation of head ‘fullness’. A superior vena cava (SVC) syndrome was clinically suspected. The patient was receiving docetaxel as a third line therapy after progression from first-line platinum-based chemotherapy and second-line immunotherapy, and had a central venous access device (CVAD) implanted 12 months earlier. A chest radiograph showed a bilateral pleural effusion and a widened mediastinum. Thoracic contrast-enhanced computed tomography (CT) confirmed a nodular soft-tissue filling defect in the SVC consistent with a thrombus and causing a severe stenosis of its lumen (Fig. 1A and B). Since the thrombus was encircling the CVAD catheter a bland clot was initially suspected, and the patient was started on anticoagulation therapy. However, the patient’s symptoms did not improve and visible venous collaterals developed along the chest wall. A whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT (PET/CT) performed 3 days later revealed a focus of intense FDG uptake at the level of the SVC thrombus, confirming a tumor thrombus (Fig. 1C–E). The CVAD was extracted and palliative radiation therapy (20 Gy in 5 fractions) was administered to the patient, achieving excellent symptomatic relief of the SVC syndrome (Fig. 1F).

中文翻译：

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在植入中心静脉通路装置和上腔静脉综合征的肺癌患者中区分平淡与肿瘤血栓：18F-FDG PET/CT 发现

一名患有 IV 期肺癌的 52 岁男性因进行性呼吸急促、颈部轻度肿胀和头部“胀满”感而入院。临床怀疑上腔静脉（SVC）综合征。该患者在一线铂类化疗和二线免疫治疗进展后接受多西他赛作为三线治疗，并在 12 个月前植入了中心静脉通路装置 (CVAD)。胸片显示双侧胸腔积液和纵隔增宽。胸部对比增强计算机断层扫描 (CT) 证实 SVC 中的结节性软组织充盈缺损与血栓一致，并导致其管腔严重狭窄（图 1A 和 B）。由于血栓环绕着 CVAD 导管，因此最初怀疑是无色凝块，患者开始抗凝治疗。然而，患者的症状并没有改善，并且沿胸壁出现可见的静脉侧枝。3 天后进行的全身 18F-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描 (PET)/CT (PET/CT) 显示 SVC 血栓水平的 FDG 强烈摄取的焦点，证实了肿瘤血栓（图 1C -E)。摘除 CVAD 并对患者进行姑息性放射治疗（20 Gy，5 次），实现了 SVC 综合征的良好症状缓解（图 1F）。3 天后进行的全身 18F-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描 (PET)/CT (PET/CT) 显示 SVC 血栓水平的 FDG 强烈摄取的焦点，证实了肿瘤血栓（图 1C -E)。摘除 CVAD 并对患者进行姑息性放射治疗（20 Gy，5 次），实现了 SVC 综合征的良好症状缓解（图 1F）。3 天后进行的全身 18F-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描 (PET)/CT (PET/CT) 显示 SVC 血栓水平的 FDG 强烈摄取的焦点，证实了肿瘤血栓（图 1C -E)。摘除 CVAD 并对患者进行姑息性放射治疗（20 Gy，5 次），实现了 SVC 综合征的良好症状缓解（图 1F）。