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In addition to the gigantic venous collaterals over this patient’s abdomen, smaller venous channels (not shown) were visible overthe lateral portions of her thorax and along each side of her lumbar spine. The pattern of venous collaterals shown, however, is pathognomonic of inferior venacaval obstruction.
Transfemoral venography in this woman verified total occlusion of her inferior vena cava at its distal end. Although the causewas never identified, the patient said that her “snakes” had been present for 20 years.
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