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Images of Memorable Cases: Case 62

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

Case_62-pres1-1.jpg

Two months before admission, this 37-year-old woman noticed bluish-red streaks in the skin near her left sternoclavicular joint. Soon thereafter, hoarseness and hemoptysis developed.

62. Venous stars heralding carcinoma of the lung

The image shows fullness in the left supraclavicular space; a distended, left-sided, neck vein; striking venous stars (cutaneous venules); and deeper dilated veins in the left upper thoracic area. Biopsy of a hard, left-sided, supraclavicular mass disclosed poorly differentiated squamous carcinoma.

As this case demonstrates, the sudden appearance of venous stars on the upper chest or shoulder may be the earliest manifestation of an obstructed great thoracic vein. Indeed, further study of this patient disclosed total occlusion of her left subclavian and innominate veins. For more information on venous stars, see Case 146.

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