CASE

A 44-year-old female with a history of acute intermittent porphyria (AIP) had a port placed 20 years ago for porphyria-related infusions at a time when she was having 3 exacerbations per year. 8 years ago, she presented for catheter-related distal SVC occlusion, resulting in the placement of a placement of 14 mm x 4 cm uncovered stent in the SVC.

She now presents to IR clinic with several months of shortness of breath at night and intolerance of even mild physical exertion. She sleeps with 4-5 pillows (normally sleeps with 1 pillow) and has noticed some mild facial swelling.

Which of the following imaging studies would you order for further interrogation?

A.       CT chest without contrast

B.       CT angiography

C.      DVT ultrasound

D.      CT venogram