A rare case of non-oncologic metastasis: Keep calm and check the veins

We report the case of a 57-year-old patient with short bowel syndrome and chronic intestinal failure secondary to multiple resections for Crohn's disease, requiring parenteral nutrition (PN) since 1997. During an annual follow-up, the patient reported difficulties with his central venous access. Computed tomography (CT) revealed pseudo-sclerotic lesions of the T1-T3 vertebrae, suggestive of metastatic disease. Further imaging showed severe stenosis of the superior vena cava related to chronic thrombosis of the central venous line. Endovascular dilatation of the stenosed vein led to complete resolution of the lesions. This phenomenon, known as "vanishing bone metastases" (VBM), results from contrast reflux into collateral venous pathways, and can mimic bone metastases. Lack of recognition of this rare but significant radiological artifact may lead to unnecessary invasive procedures. Awareness of VBM is crucial, especially in patients on long-term PR who are at high risk of thrombosis, to prevent misdiagnosis and improve patient care.