In central venous obstruction, vertebral marrow enhancement (VME) may be seen secondary to collateral venous flow via the vertebral venous plexus. 1 There are only sporadic case reports on pseudolesions due to collateral enhancement mimicking sclerotic osseous metastasis. This abnormal vertebral enhancement may lead to erroneous diagnosis of sclerotic metastases or suspicious bone lesion which affect the management and prognosis. We describe a case of brachiocephalic vein obstruction-related vertebral body pseudolesions as identified in contrast-enhanced computed tomography (CECT) scan