A 27-years-old female with history of venous thromboembolism secondary to Lupus anticoagulant presented with sudden onset of chest pain and dyspnea. A CT angiogram of the chest showed superior vena caval (SVC) obstruction with anterior chest wall venous collaterals and hepatic portal vein gas (HPVG), which resolved without intervention on a repeated CT-scan of the abdomen. Previously, HPVG was considered to be a dangerous radiologic sign, however with the advancement in imaging technology more benign causes are being identified. This case highlights that this finding alone, if found, does not indicate aggressive management and that clinical correlation should be considered if found.
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