OBJECTIVE The purpose of this retrospective study is to describe the CT features of vertebral venous congestion simulating sclerotic metastases in nine patients with thrombosis of the superior vena cava. METHODS We analyzed all cases of obstruction of the superior vena cava recorded in our radiologic teaching files since 2006, to identify cases with vertebral venous congestion simulating sclerotic metastases. The following CT features were analyzed: the underlying cause, exact level, and length of the venous obstruction; the pattern of collateral venous pathways visualized as enlarged and densely opacified vascular channels; and the characteristics of the vertebral venous congestion. RESULTS Nine patients referred for CT examinations between 2006 and 2014 were included in the present study. The pathways that underwent contrast enhancement included the anterior or lateral thoracic pathways in eight patients, the mediastinal pathways in seven patients, and the azygos and vertebral pathways in nine patients. Vertebral venous congestion was observed in 30 vertebrae and was specifically noted in the vertebral body (n = 25), pedicle (n = 11), lamina (n = 3), and spinous process (n = 1). The density of vertebral bone enhancement ranged from 413 to 1480 HU. The limits were well defined in eight lesions and ill defined in 22 lesions. In 23 lesions, a vessel was noted within the vertebrae, in close contact with the vertebrae, or in both locations. CONCLUSIONS Development of a vertebral venous collateral system can lead to vertebral venous congestion, resulting in focal and patchy enhancement of the vertebrae, which can be mistaken for sclerotic metastases.