Pseudolesion in a patient with superior vena cava syndrome

This 56-year-old-man presented with 2 month history of hemoptysis and weight loss and recently developed shortness of breath and swelling of the arms and face. Computed tomographic (CT) scan showed a large right mediastinal and paramediastinal mass encasing the major airway and the large mediastinal vessels with marked narrowing of the superior vena cava (SVC) (Fig. 1), multiple chest wall and mediastinal collaterals, and confluent mediastinal and hilar adenopathy with lymphangitis carcinomatosis. The arterial phase showed a hyperenhancing area in the medial segment of left lobe of liver with multiple collateral vessels, which was diagnosed as a pseudolesion secondary to cavo-mammary-phrenic-hepatic capsule-portal shunting due to SVC obstruction [1] (Figs. 2 and 3). Pseudolesions of the liver are common and radiologists should be aware of them to avoid unnecessary examination and biopsy. They may be due to transient extrinsic compression of the liver by ribs, diaphragm or abdominal muscles; or due to inflow of blood from cholecystic veins, the parabiliary venous system, the epigastric-paraumbilical venous system, or the cavomammary-phrenic-hepatic-capsule-portal pathway. In