Objectives

To review imaging findings of tumor vein trombosis.

To describe and illustrate examples of different vein tumor thrombosis with significant diagnostic (and therapeutic) implications.

Background

Venous tumoral thrombosis can be imaged with US, CT or MRI. Its appearance and imaging findings, especifically differentation of a bland thrombus from tumoral thrombus, are well described in the literature.

Imaging findings OR Procedure findings

Venous tumoral thrombosis significance varies in different clinical settings: tumor thrombus in hepatocellular carcinoma is a contraindication for liver transplantation but on the other hand tumor thrombus not represent an absolute contraindication for surgery in the setting of a pancreatic neuroendocrine tumor.
Venous tumoral thrombosis is an important -and sometimes unreported- finding: 1) Infiltrating hepatocellular carcinoma is often difficult to detect on cross-sectional imaging studies given its “non-classic” appearance. Infiltrating HCC usually presents as a subtle poorly demarcated area within the liver characterized by heterogeneous signal intensity. One important clue to correct diagnosis is to identify portal vein thrombosis. 2) In the setting of a pancreatic mass, the presence of macroscopic tumor thrombus is an important diagnostic clue because it’s rarely associated with usual pancreatic adenocarcinoma, but is found in association with pancreatic neuroendocrine tumors.

Conclusion

Radiologists must be aware that the presence of some specific forms of venous tumor thrombosis are an important diagnostic clue, with variable clinical –surgical impact .