Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt

The development of venous collaterals is a sine quo non of a number of diverse clinical entities. Of them, the systemic-to-pulmonary venous collaterals are rather uncommon. These collaterals, though essentially owe their birth to a complete superior vena cava obstruction, may be of diverse kinds. Categorized traditionally into anatomical, congenital or acquired varieties, they produce a right-to-left shunt and leave the patient susceptible to embolic stroke, brain abscess and a high cardiac output state.1 Among these uncommon shunts, the rarest is the acquired kind. We present a case of a 90-year-old female with lung malignancy, who developed such an acquired shunt. A robust knowledge of such an event is critical from the perspective of understanding potential complications and taking timely steps to mitigate them.