Focal hepatic hot spot sign: Clinical image

A 51‐year‐old women was hospitalized to start chemotherapy for small cell lung cancer diagnosed one months earlier. She underwent Computed Tomography (CT) of the chest and abdomen to re‐evaluate the progression of the lung tumour. Contrast-enhanced CT of the chest indicated an invasive anterior left lung tumour that caused an obstruction of the Superior Vena Cava (SVC) (Figure 1). Contrast-enhanced CT of the abdomen revealed an intense focal wedge-shaped homogeneous enhancement area in the quadrate lobe of the liver, which is known as the hot spot sign (Figure 2). Focal hepatic hot spot sign was first described by Ishikawa in 1983. The sign can be observed on technetium 99m (99mTc) Sulphur colloid scans or on contrast, material enhanced CT scans [1]. Hot spot sign is caused by portosystemic venous shunting between the superior vena cava and the left portal vein via the internal mammary and paraumbilical veins along the ligamentum teres, secondary to superior vena cava obstruction. The hot spot is created by areas of focally increased blood flow that result from this shunting [2]. Stanford and colleagues classified SVC syndrome into four types - type I and type II referred as supra-