Usually, the radiotherapist or oncologist is summoned to administer emergency. The superior vena cava syndrome svcs comprises various symptoms due to occlusion of the svc, which can be easily obstructed by pathological conditions eg, lung cancer, due to the low internal venous pressure within rigid structures of the thorax trachea, right bronchus, aorta. Gradual obstruction of the superior vena cava produces a syndrome which is characterized by venous distention and edema of the head, neck, and upper. Superior vena cava syndrome, topics in thoracic surgery, paulo f. Treatments for superior vena cava syndrome including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. Superior vena cava syndrome presenting as position. Superior vena cava syndrome svcs occurs when a persons superior vena cava is partially blocked or compressed.
We report a case of superior vena cava syndrome svcs caused by squamous cell lung carcinoma in a 49yearold man. Superior vena cava svc syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0. Introduction superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. It carries blood from the head, neck, upper chest, and arms to the heart. Since all effective therapy is inherently harmful, it would be reassur ing to have a definitive tissue diagnosis before in itiating treatment. Figure 3 summarizes a treatment algorithm for the management of malignant svcs. The photograph shows massive engorgement of collateral subcutaneous veins of the chest and abdomen in a 58yearold man with partial obstruction of the. Endovascular stenting for endstage lung cancer patients. Superior vena cava syndrome revealing a behcets disease. Treatment should also be individualized and should not be undertaken until a diagnosis is obtained. Feb 29, 2016 superior vena cava syndrome svcs is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. Treatment depends on the etiology of the obstructive process. Multimodality treatment of malignant superior vena caval syndrome. Superior vena cava syndrome and telangiectasia in a man.
He presented with severe edema of the face and upper half of the body with numerous dilated and tortuous cutaneous veins. Superior vena cava syndrome an overview sciencedirect topics. Lung sounds were normal bilaterally, and neither the upper nor lower extremities were edematous. William hunter first described the syndrome in 1757 in a patient with syphilitic aortic aneurysm. We here report a case of superior vena cava syndrome in childhood. It is a largediameter 24 mm short length vein that receives venous return from the. Coronal mip reconstruction carried out 4 weeks after starting treatment. The superior vena cava syndrome svcs is a rare pathological process caused by the superior. Mediastinal fibrosis mf is one of the most common nonmalignant causes of superior vena cava syndrome svcs. If you continue browsing the site, you agree to the use of cookies on this website. Superior vena cava syndrome occurs when a major vein that can become blocked either with a blood clot or a cancerous tumour.
In superior vena cava syndrome svcs, this vein has. Patients have a cough and dyspnea, particularly when supine, and they have swelling of the head and upper extremities as a result of venous compression. Superior vena cava obstruction evaluation with mdct. Congenital or acquired abnormalities can affect the. Although the exact incidence of superior vena cava syndrome remains unknown, the condition affects about 15 000 patients in the united states each year. Superior vena cava svc syndrome is a major complication that occurs when a growing lung malignancy compresses the svc extrinsically.
The drawing below shows where the superior vena cava is located in the body. Superior vena cava syndrome svcs is a medical condition which consists of the obstruction of blood flow through the superior vena cava. The treatment of choice is irradiation, but in resistant cases or in. Svcs is a significant disorder affecting up to 10 % of small cell lung cancer sclc patients and 24 % of all lung cancer patients. Right atrium reappeared at postoperative ctscan fig. A restriction of the blood flow occlusion through this vein can cause superior vena cava syndrome svcs. Superior vena cava syndrome svcs results from the impair. Thrombosis of the superior vena cava, however, is less common when it is not related to central venous catheters in the subclavian vein or the superior vena cava.
Superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper. We report a patient with svc syndrome secondary to documented ipsilateral peritracheal nodal involvement stage iiib disease who underwent neoadjuvant chemoradiotherapy. A patient with svcs requires immediate diagnostic evaluation and therapy. Superior vena cava syndrome an overview sciencedirect. Superior vena cava svc syndrome is a critical condition in which an intrathoracic mass lesion compresses the svc and. Superior vena cava syndrome in a person with bronchogenic carcinoma. To know the main causes of svcs in a third level hospital. The superior vena cava syndrome svcs is defined as the set of signs and symptoms derived from superior vena cava obstruction, both intrinsic obstruction and extrinsic compression, which causes an increase in venous pressure in the upper. Svcs is a medical emergency if associated with laryngeal or cerebral edema. The superior vena cava syndrome svcs is a rare pathological process caused by the superior vena cava obstruction svco. Superior vena cava syndrome caused by an idiopathic localized. A 75yearoldfemale was emergently admitted for superior vena cava syndrome due to right atrial primary bcell lymphoma occluding superior vena cava and suboccluding the inferior one. He underwent an enhanced computed tomography ct examination for suspected superior vena cava syndrome, which revealed narrowing and partial thrombosis of the superior vena cava at the site of the catheter tip with retrograde flow into the azygous vein fig.
Francesco puma and jacopo vannucci february 15th 2012. A reassessment of the clinical applications of the superior vena cava syndrome. Nonmalignant superior vena cava syndrome in a patient. Superior vena cava syndrome has historically been associated with malignancy. Tracheobrochial compression could have also contributed to our patients breathing difficulties. Superior vena cava syndrome definition of superior vena. Although we initially considered this case to be a drug eruption because the patient had repeated episodes of worsening clinical presentation whenever he took. Thrombectomy, thrombosis, superior vena cava syndrome, superior vena cava obstruction doi. Superior vena cava syndrome in a patient with smallcell lung.
Superior vena cava syndrome svcs is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. Medical management of the thoracic surgery patient, 2010. A computed tomography angiography showed a thrombotic obstruction of svc. Malignancies are the main cause and are considered an oncologic emergency. Superior vena cava syndrome is characterised by dyspnoea, headache, facial oedema, and venous distention in the neck, upper chest and arms. Superior vena cava syndrome svcs is rare in childhood. Treatment should also be individualized and should not be undertaken until a. Superior vena cava an overview sciencedirect topics. Superior vena cava syndrome is a clinical diagnosis, and associated imaging findings include widening of the mediastinum on radiographs and mediastinal soft tissue on ct, interruption of contrast material within the superior vena cava on contrastenhanced ct. Five patients had nonhodgkins lymphoma, two had hodgkins disease, two had benign lesions, and one patient was suspected on clinical and radiologic basis to have a lymphoma.
The superior vena cava svc is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. Nonmalignant causes can include aneurysm of the aorta, thromboses after implanted intravascular catheters or fibrosing mediastinitis. Review of evolving etiologies, implications and treatment strategies. Review of evolving etiologies, implications and treatment. Surgical treatment of benign superior vena cava syndrome. Superior vena cava obstruction radiology reference article. The majority of cases are caused by malignant tumors within the mediastinum, most commonly lung cancer and nonhodgkins lymphoma, directly compressing or invading the svc wall. Surgical management of superior vena cava syndrome. Observational, prospective and descriptive study in 31 patients with svcs treated between june 20 and december 2014. Experience with ten children with superior vena cava obstruction is reported. A 47yearold woman reported the appearance of venous ectasias in the right side of her chest, face and neck. Superior vena cava syndrome svc syndrome slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In anatomy, a persistent left superior vena cava plsvc is the most common variation of the thoracic venous system, is prevalent in 0.
It is a largediameter 24 mm short length vein that receives venous return from the upper half of the body, above the diaphragm. Lung cancer is the most common cause of superior vena cava syndrome svcs and requires timely recognition and management. We report a 37yearold man hospitalized because of swelling of the face and neck. The patient was treated by percutaneous transluminal balloon angioplasty of the svc and placement of a stent. Figure 1 prominent periorbital oedema and facial swelling after lying down the night before as a presenting symptom of superior vena cava syndrome. The superior vena cava syndrome svcs comprises various symptoms due to occlusion of the svc, which can be easily obstructed by pathological conditions eg, lung cancer, due to the low internal. He was a 10yearold boy with benign encapsulated thyroid tumor with predominating respiratory symptoms and signs. Superior vena cava svc syndrome is a relatively common complication of lung cancer. Chronic upper extremity deep vein thrombosis uedvt and superior vena cava syndrome svcs are becoming increasingly common due to the use of indwelling catheters and implantable central venous. Diagnosis of superior vena cava syndrome svcs was made and the patient was referred to the pulmonologist. Superior vena cava syndrome svcs is an acute or subacute oncologic emergency with typical clinical features. In the preantibiotic era, the untreated infections were the.
The treatment of choice is irradiation, but in resistant cases or in those instances in which radiation tolerance is. Mar 17, 2015 superior vena cava syndrome svc syndrome slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Superior vena cava syndrome presenting as positiondependent. Superior vena cava syndrome mediastinal syndrome other names. The superior vena cava is a major vein in a persons body. Superior mediastinal syndrome, also called superior vena cava syndrome results from the presence of an anterior mediastinal mass that compresses the trachea and the superior vena cava. Superior vena cava syndrome in thoracic malignancies. In patients with suspected superior vena cava syndrome, mdct has the unparalleled advantage of onestop shopping, combining crosssectional imaging for diagnosis of the cause of the superior vena cava obstruction with multiplanar reformation that best delineates the level and extent of venous obstruction and is invaluable to the surgeon. Treatment of mediastinal syndrome involves chemotherapy and radiation, radiation alone or surgery according to the etiology.
Superior vena cava syndrome svcs is a group of symptoms that can occur in people who have lung cancer, lymphoma, or other cancers that involve the center of the chest. Superior vena cava svc obstruction can occur from extrinsic compression, intrinsic stenosis, or thrombosis. Definition the superior vena cava is the major vein in the chest that carries blood from the upper part of the body in to the heart. Figure 2 chest radiography showing a broadened mediastinum with shading of the. Superior vena cava syndrome svcs is mechanical obstruction of the superior vena cava svc due to venous thrombi or extrinsic compression by intrathoracic tumours in most cases. Thrombosis is a rare cause of superior vena cava svc syndrome. Congenital or acquired abnormalities can affect the diameter of svc. Pdf superior vena cava syndrome in childhood fausto. Computed tomography ct panel d showed that the mass extended to the superior vena cava svc, both subclavian veins and to the inferior vena cava. Superior vena cava syndrome is the most severe complication of mediastinal syndromes and is considered to be a medical emergency 1,2. Superior vena cava svc syndrome, a potential oncologic emergency, is closely associated with malignancy and.
The superior vena cava is one of the primary veins within our bodies. We present the case of a patient with behcets disease which was discovered during a superior vena cava syndrome. Mediastinoscopy in advanced superior vena cava obstruction. The treatment of the benign svc syndrome is focused on achieving longterm durability and patency of the superior. We report a case of superior vena cava thrombosis in a 53yearold woman receiving chemotherapy for breast carcinoma through. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the svc. Diagnosis could be confirmed in 17 cases as one child succumbed to. Symptoms of the syndrome include shortness of breath. Description superior vena cava syndrome is a partial occlusion of the. Open surgery repair for superior vena cava syndrome after.
Superior vena cava syndrome is diagnosed by ultrasound, chest xray, ct scan, and in some cases biopsy. It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax. The superior vena cava syndrome svcs comprises various symptoms due to occlusion of the svc, which can be easily obstructed by pathological conditions eg, lung. A patient with superior vena cava syndrome may experience respiratory problems and coughing, which are often exacerbated when the patient is supine because gravity engages the mass directly against the superior vena cava. The patient was affected by systemic lupus erythematous with antiphospholipid syndrome and endstage. Currently, svc syndrome is generally due to cancer or thrombotic events. Understandably, the swollen plethoric face, the conjunctival edema of chemosis, and the distended neck veins and collaterals that indicate superior vena cava syndrome svcs provoke visions of impending catastrophe.
Its affection of the superior vena cava is rather rare with only a few cases described in the literature 2,3. An intrathoracic malignancy is responsible for 60 to 85 percent of cases of superior vena cava syndrome svc syndrome, and svc obstruction is the presenting. Sep 01, 2017 the superior vena cava is one of the primary veins within our bodies. It transports blood from our arms, chest, neck, and head to our hearts. In addition, pulmonary cancer is the most common cause of mediastinal syndrome. An intrathoracic malignancy is responsible for 60 to 85 percent of cases of superior vena cava syndrome svc syndrome, and. In order to study the clinical profile of children presenting with superior vena cava syndrome svcs, case records of all children presenting with svcs over a 10year period were retrospectively analyzed. Pdf superior vena cava syndrome in thoracic malignancies. One of the benign causes of svc obstruction is the longterm use of indwelling catheters and wires, increasing the chances of svc thrombosis.
Malignant superior vena caval svc syndrome due to nonsmall cell lung cancer is invariably fatal, with most therapy directed toward palliating the manifestations of the disease. The syndrome is rarely an oncologic emergency in the absence of tracheal compression and airway compromise. The superior vena cava syndrome svcs is a rare pathological process caused. Current treatment options include radiotherapy or chemotherapy to shrink the tumor or endovascular stenting of the svc to restore flow. In this mnt knowledge center article, learn about superior vena cava. Treatment of superior vena cava thrombosis with recombinant. The syndrome was originally described as being secondary to an infection, such as tuberculosis, or a syphilitic aortic aneurysm 24. Superior vena cava syndrome svcs refers to the clinical syn. The azygos vein was markedly dilated with extensive venous collaterals noted between the superior and inferior vena cava. Thrombotic occlusion of the superior vena cava is an uncommon but serious complication of chronic indwelling venous catheters.
Several reports have shown thrombolytic therapy with intravenous streptokinase or urokinase to be effective in the treatment of this condition. Superior vena cava syndrome is a clinical diagnosis, and associated imaging findings include widening of the mediastinum on radiographs and mediastinal soft tissue on ct, interruption of contrast material within the superior vena cava on contrastenhanced ct, and opacification of collateral vascularity fig. Diagnostic procedures in patients with superior vena cava. Superior vena cava syndrome svcs, is a group of symptoms caused by obstruction of the superior vena cava svc, a short, wide vessel carrying circulating blood into the heart.
Note the swelling of his face first thing in the morning left and its resolution after being upright all day right. The obstruction of blood flow through the superior vena cava svc into the right atrium may present as a severe clinical syndrome. Infections such as tuberculosis, and extrinsic compression such as syphilitic aortic aneurysm, thymoma or thyroid goitre, are also known to cause superior vena cava syndrome. Superior vena cava syndrome svcs, a clinical manifestation arising from compression of the thinwalled superior vena cava svc, was first described by william hunter in 1757 and can be caused by a variety malignancies hunter and johnston 1757. The syndrome is almost invariably secondary to a malignant process. Pdf superior vena cava in a patient with superior vena. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or. Nonmalignant superior vena cava syndrome in a patient with. The clinical situation at presentation was often critical and required rapid treatment. Superior vena cava svc syndrome occurs in approximately 15,000 people in the united states each year. Pdf superior vena cava syndrome isabel pedraza academia.
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