Superior mesenteric vein tumour thrombus in a patient with caecal adenocarcinoma: a rare and important finding

Figures

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  Figure 1.. (a-e) Staging (a) Axial CT and (b) FDG-PET CT images showing intensely FDG-PET avid primary caecal tumour (red arrow) and partially calcified tumour thrombus in the SMV (blue arrows) extending into tributaries. Para-aortic nodal metastases are noted (white arrows). (c) Coronal and (d) Sagittal CT images confirm the extensive venous thrombus (yellow arrows) and (e) shows the caecal mass (red arrow). Bland thrombus is most likely to be on the downstream tip of tumour thrombus. FDG, Fludeoxyglucose; PET, Positron emission tomography; SMV, Superior mesenteric vein.

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  Figure 2.. (a) Axial contrast-enhanced CT abdomen showing normal non-dilated bowel loops in the lower quadrant at the level of the caecum (red arrow). (b) Axial contrast-enhanced CT abdomen performed 4 months after (a) shows significant thickening of the caecum (red arrow) with circumferential luminal narrowing and extensive surrounding fat stranding and mesenteric invasion along the medial aspect of the caecal mass (blue arrow).

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  Figure 3.. (a, b) Post-mortem CT coronal images (2 months post-CT in Figure 1) showing increased calcification in the SMV tumour thrombus (red arrows) and extending into tributaries (blue arrow). The caecal mass causing near complete luminal obstruction is also noted (white arrow). SMV, Superior mesenteric vein.

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  Figure 4.. (Aa b) Pathological axial cross-section specimen images showing infiltration of the SMV by macroscopic tumour confirmed as adenocarcinoma. SMV, Superior mesenteric vein.