Name
SUPERIOR VENA CAVAL SYNDROME
DESCRIPTION
DETAIL
CAUSES : - MALIGNANT CONDITIONS LIKE SMALL CELL CARCINOMA INVOLVING RT UPPER LOBE WITH PARATRACHEAL NODES ENLARGEMENT & MEDIASTINAL INFILTRATION. - LYMPHOMAS - MALIGNANT THYMOMA - GERM CELL TUMOURS - METASTATIC CARCINOMAS - ANEURYSM OF ASENDING AORTA & INNOMINATE ARTRY ( RARE ) - LARGE RETROSTERNAL GOITRE - CHR FIBROUS MEDIASTINITIS SECONDARY TO TUBERCULOSIS, HISTOPLASMOSIS, COCCIDIOIDOMYCOSIS, BLASTOMYCOSIS OR FILARIAL MEDIASTINAL LYMPHADENITIS - THROMBOSIS FOLLOWING INTRODUCTION OF SUBCLAVIAN LINE OR PACEMAKER WIRES - SECONDARY TO AXILLARY VEIN THROMBOSIS -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS : β’ Aortic aneurysm β’ Tuberculosis, Histoplasmosis β’ Fungal infectionsOTHER TESTS : * SPUTUM FOR CELL CYTOLOGY * Increased central venous pressure (CVP), usually 20-50 mm Hg. IMAGING : β’ Chest x-ray abnormal in 96% with mediastinal widening in 51% and right hilar mass in 48% β’ MRI, CT scan, and/or tomography - mediastinal mass, superior mediastinal mass, pulmonary lesion, superior vena cava obstruction, hilar adenopathy, pleural effusion. β’ Tc 99m scan - block to fl ow of contrast material into right heart, large collateral veins β’ Venography - superior vena cava obstruction DIAGNOSTIC PROCEDURES : β’ Bronchoscopy (diagnostic in 54%) β’ Thoracentesis, thoracotomy, lymph node biopsy, as indicated
TYPENOTES
RISK FACTORS : HIV infectionGENERAL MEASURES : β’ Chemotherapy (treatment of choice for high grade lymphomas, general tumors and small cell lung cancer) β’ Intravascular stenting β’ Radiotherapy β’ Neoadjuvant chemoradiotherapy and then resection β’ Thrombolytic therapy if catheter-induced SURGICAL MEASURES : Superior vena cava reconstruction for benign processes may be considered. Case report stage IIIB non-small cell lung cancer treatment response with chemoradiation, then resection. DRUG(S) OF CHOICE : β’ Chemotherapy for cancer β’ Steroids for some malignancies, especially if cerebral or laryngeal edema β’ Antifungal or antitubercular medications according to underlying cause β’ Consider diuretics β’ Anticoagulation role unclear β’ Fibrinolytics (e.g., urokinase) for thrombosis PATIENT MONITORING : Linked to cause. If infection, monitor for evaluation of antimicrobial treatment. If malignant, monitor response to radiotherapy or chemotherapy. PREVENTION/AVOIDANCE: No preventive measures known POSSIBLE COMPLICATIONS Complications of underlying disease EXPECTED COURSE/PROGNOSIS: High probability of response; prognosis linked to cause; 20% 1-year survival for lung cancer; 50% 2-year survival for lymphoma. 85% neoplastic cases better in 3 weeks with radiation therapy, but symptoms usually recur.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ABSOLUTE EOSINOPHIL COUNT, MONTOUX TEST, FNAC, X-RAY CHEST P.A. VIEW( NORMAL ), COMPLETE BLOOD COUNT, CT SCAN THORAX, BRONCHO-ALVEOLAR LAVAGE FOR CYTOLOGY, BRONCHOSCOPY, BRONCHOGRAPHY, MRI, BIOPSY