"Hot quadrate lobe spot" sign in chronic superior vena cava obstruction.

We report the case of a 65-year-old male patient who consulted for swelling of the face and neck after having a pacemaker implantated. Contrast-enhanced chest computerized tomography (CT) confirmed a thrombus within the superior vena cava (SVC). Thus, therapy with oral anticoagulants was initiated, which obtained a good clinical response and resolution of symptoms. A follow-up contrast-enhanced CT scan of the chest and abdomen showed a focal, well-delimited, hyperdense area in the IV hepatic segment during the arterial and portal venous phases, which was associated with persistence of the SVC repletion defect and the presence of multiple superficial venous collaterals in the right anterolateral thoraco-abdominal wall. The hepatic image corresponded to the sign of the "hot spot" or "hot quadrate lobe", a hepatic pseudolesion that should not be confused with other focal hypervascular lesions.