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"Hot quadrate lobe spot" sign in chronic superior vena cava obstruction

Cristina Gómez Varela1, Iria Couto Rodríguez2

  • 1Radiodiagnóstico , Complejo Hospitalario Universitario de Pontevedra, España .

Revista Espanola De Enfermedades Digestivas
|July 28, 2021
PubMed

Insights

A pacemaker recipient developed facial and neck swelling due to a superior vena cava (SVC) thrombus. Anticoagulant therapy resolved symptoms, and follow-up imaging revealed a hepatic pseudolesion, the "hot spot" sign.

Area of Science:

  • Cardiology
  • Radiology
  • Vascular Medicine

Background:

  • Pacemaker implantation can lead to complications such as venous thrombosis.
  • Superior vena cava (SVC) thrombus is a potential risk following device implantation.
  • Accurate diagnosis of SVC thrombus and associated findings is crucial for patient management.

Observation:

  • A 65-year-old male presented with facial and neck swelling post-pacemaker implantation.
  • Contrast-enhanced chest CT confirmed a thrombus in the SVC.
  • Follow-up CT revealed a hepatic pseudolesion, the "hot spot" sign, alongside persistent SVC thrombus and collateral vessel formation.

Findings:

  • Oral anticoagulant therapy led to clinical improvement and symptom resolution.
  • The "hot spot" or "hot quadrate lobe" sign is a specific hepatic pseudolesion.
  • This pseudolesion should be differentiated from true hypervascular hepatic lesions.

Implications:

  • Early recognition and anticoagulation are vital for managing SVC thrombus post-pacemaker.
  • Understanding the "hot spot" sign aids in accurate radiological interpretation.
  • This case highlights the importance of comprehensive imaging follow-up for pacemaker-related complications.

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