case_images: PMC11195026_01
case_images: Venogram: Upper arrow (black) shows collateral vein formation. The lower arrow (white) shows the normal anatomical position of SVC as it enters the right atrium.
case_images: acc-11-02-10288-g001.jpg
case_images: PMC11195026_01_acc-11-02-10288-g001.jpg
case_images: f1
case_images: High-dose direct oral anticoagulation (Rivaroxaban 15mg bd) was started, but despite this, symptoms worsened and an invasive venogram with a 4 French sheath and pigtail catheter at the confluence of the brachiocephalic veins confirmed the presence of a tight web-like stenosis at the azygous vein level (Figure 1).
case_images: Chest X-ray demonstrating a large right-sided pleural effusion requiring Seldinger drain insertion.
case_images: acc-11-02-10288-g002.jpg
case_images: PMC11195026_01_acc-11-02-10288-g002.jpg
case_images: f2
case_images: Prior to surgery the patient re-presented with worsening breathlessness and was found to have a large right-sided pleural effusion (Figure 2).
case_images: Chest drain demonstrating pink milky fluid.
case_images: acc-11-02-10288-g003.jpg
case_images: PMC11195026_01_acc-11-02-10288-g003.jpg
case_images: f3
case_images: A Seldinger drain was inserted, which removed a total of 6.5 liters of lipid-rich fluid (Figure 3).
case_images: Convalescent chest X-ray demonstrating right-sided blunting at the costophrenic angle.
case_images: acc-11-02-10288-g004.jpg
case_images: PMC11195026_01_acc-11-02-10288-g004.jpg
case_images: f4