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Images of Memorable Cases: Case 146

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_146-pres1-1.jpg Case_146-pres1-2.jpg

This 60-year-old man presented with a two-week history of hemoptysis. Four months earlier, he had noticed the onset of numerous small, painless, bluish discolorations all over the anterolateral portions of his chest. He assumed they were bruises.

146. Venous stars heralding superior vena caval syndrome

On physical examination, this man had the full- blown picture of superior vena caval obstruction, proven at autopsy one month later to result from bronchogenic carcinoma. Particularly striking were the many small, dilated, superficial, cutaneous veins—called “venous stars”—that constituted the first objective evidence of mediastinal disease.

Ordinarily, venous stars are not clinically significant. They occur commonly over the thighs, lower legs, dorsum of the feet, and ankles. Moreover, they are frequent along the lower borders of the ribs, in the lower lumbar and upper sacral regions, and over the back, particularly at the junction of the neck and thorax. But when they suddenly appear in the anterolateral thoracic area, they strongly suggest a recent occlusion of one or more of the great thoracic veins.

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