Appropriate imaging techniques are important to confirm the diagnosis and rule out other causes of svc syndrome. He was admitted to our hospital for chest pain, but had no murmur. The photograph shows massive engorgement of collateral subcutaneous veins of the chest and abdomen in a 58yearold man with partial obstruction of the superior vena cava caused by smallcell lung cancer. Superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. The treatment of choice is irradiation, but in resistant cases or in.
A 42yearold man presented to his local hospital with sepsis. The patient also had distended neck veins but minimal facial edema. He was cyanotic and had finger clubbing with oxygen saturation of 85% to 90%. Historically, and in other parts of the world, infection syphilis and tuberculosis is another cause of superior vena cava syndrome. The syndrome is rarely an oncologic emergency in the absence of tracheal compression and airway compromise. 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. Lymph nodes that drain the entire right chest and lower portion of. Malignant obstruction of the superior vena cava nejm. Review of evolving etiologies, implications and treatment. Superior vena cava svc syndrome is the result of stenosis or occlusion of the svc or bilateral brachiocephalic veins. William hunter first described the syndrome in 1757 in a patient with syphilitic aortic aneurysm. Venography showed occlusion of the superior vena cava. Superior vena cava svc syndrome results from any condition that leads to obstruction of blood flow through the svc. Superior vena cava syndrome svcs is a collection of symptoms that usually occur in patients who have lung cancer, nonhodgkin lymphoma, or other cancers.
Introduction superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. Superior vena cava syndrome svcs is a relatively common sequela. Lung cancer is the most common cause of superior vena cava syndrome svcs and requires timely recognition and management. Nonsmall cell lung cancer nsclc is the most common malignant cause of svc syndrome, accounting. 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 syndromea proposed classification system and algorithm for management. The superior vena cava is one of the primary veins within our bodies. This simple keywords research tool will give you a list of the most popular keywords. This summary explains svcs and its treatment in adults and children. One was lack of or decreased opacification of central venous structures distal to the site of obstruction. A computed tomographic pulmonary angiogram led to an initial diagnosis of leftsided superior vena cava and partial anomalous pulmonary venous drainage. Treatment should also be individualized and should not be undertaken until a. Treatment depends on the etiology of the obstructive process.
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. A case of malignant superior vena cava syndrome presenting as. Images in clinical medicine from the new england journal of medicine superior vena cava. The patient with superior vena cava syndrome might complain of headache, dysphagia, hoarseness, or shortness of breath. Symptoms include swelling of the face and arms associated with shortness of breath. The right and left brachiocephalic veins join to form the svc. All words related to superior vena cava syndrome from a to z. Diagnosis and management of superior vena cava syndrome. Svc syndrome is extrinsic or intrinsic obstruction of blood flow through the svc, leading to proximal congestion. Superior vena cava syndrome an overview sciencedirect. It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax. The svcs function of returning blood from the upper half of the body, and its location anterior to the trachea at the right margin of the sternum, helps explain the typical signs and symptoms of the superior vena cava syndrome.
Malignancyrelated superior vena cava syndrome uptodate. Description superior vena cava syndrome is a partial occlusion of the. The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper. A 59yearold man with hypertension and crohns disease that was complicated by fistulas was found unconscious at home. The dialysis catheter, inserted into the left internal jugular vein under fluoroscopic guidance, showed a left superior vena cava draining into the. Currently, svc syndrome is generally due to cancer or thrombotic events. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or. Superior vena cava syndromea proposed classification system and algorithm. Review of evolving etiologies, implications and treatment strategies. Blood clot thrombus formation that causes superior vena cava syndrome is a complication of pacemaker wires,dialysis, and other intravenous catheters that are threaded into the superior vena cava. Superior vena cava syndrome with malignant causes nejm.
Superior vena cava syndrome discharge care what you. In superior vena cava syndrome svcs, this vein has become obstructed or compressed to some degree. Contrastenhanced computed tomographic imaging of the chest revealed a markedly compressed superior vena cava svc. Superior vena cava syndromecausessymptomstreatment.
Know what is superior vena cava syndrome, its causes, symptoms, treatment and prognosis. Superior vena cava syndrome svcs develops when your superior vena cava is partially or fully blocked. In the event of svc obstruction, venous pressure in collateral vessels. 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. In superior vena cava syndrome svcs, this vein has. San francisco, california nalthough the superior vena cava syndrome is a well. Chronic occlusion of the superior vena cava resulting in. The clinical diagnosis of svc syndrome is based largely on history and physical examination. Superior vena cava syndrome is a pathological condition in which the superior vena cava gets obstructed or impinged. A case of malignant superior vena cava syndrome presenting. See next steps if you are interested in a career in oncology and are looking for more resources and information on conferences. Pdf a 59yearold man with hypertension and crohns disease that was complicated by fistulas was found.
Images in clinical medicine from the new england journal of medicine superior vena cava syndrome. Superior vena cava syndrome etiology bmj best practice. Blood from your upper body normally flows through the superior vena cava and into the right side of your. Stridor, facial and arm swelling, headache and cough in a patient with metastatic nsclc are not solely manifestations of svc syndrome. 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.
Lung cancer is the most common etiology, nonsmall cell lung cancer accounting for 50% of cases of malignant svc syndrome and small cell lung cancer for 25% cases. Superior vena cava svc syndrome occurs in approximately 15,000 people in the united states each year. Pathophysiological mechanisms superior vena cava syndrome svcs is a partial or complete obstruction of the blood flow returning to the heart from the head, neck, upper thorax, and upper extremities. A restriction of the blood flow occlusion through this vein can cause superior vena cava syndrome svcs. Svcs is a significant disorder affecting up to 10 % of small cell lung cancer sclc patients and 24 % of all lung cancer patients.
Superior vena cava syndrome svcs is an acute or subacute oncologic emergency with typical clinical features. 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 overview of the risk factors, pathology, and clinical manifestations of lung cancer view in chinese. Superior vena cava syndrome facts superior vena cava syndrome is most often caused by compression of the vein the superior vena cava, that returns blood from the upper body back to the right atrium of the heart by tumor. He was intubated and brought to the emergency department. A patient with svcs requires immediate diagnostic evaluation and therapy. Michael mcfadden the superior vena cava and its important intrathoracic venous tributaries are located in a tight compartment within the superior mediastinum, immediately adjacent and anterior to the trachea and right main bronchus. The syndrome was originally described as being secondary to an infection, such as tuberculosis, or a syphilitic aortic aneurysm 24. Clinical condition that occurs due to obstruction of the superior vena cava. The primary reason behind this compression or impingement is believed to be malignant tumors especially of the lungs. Importance of collateral vessels it was believed at that time that ct diagnosis of obstruction of the superior vena cava svc or its major tributaries required at least two findings. Superior vena cava syndrome secondary to aortic disease. Symptoms of the syndrome include shortness of breath.
Superior vena cava syndrome approach bmj best practice. 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 symptom of a previously undiagnosed tumor in up to 60 percent of these cases 4,6,7. Superior vena cava syndrome definition of superior vena. An undiagnosed subclavian vein thrombosis or sagittal sinus thrombosis would be inappropriately treated with most appropriate initial therapy of radiation and result in pe or sudden death.
Superior vena cava syndrome in thoracic malignancies. Superior vena cava svc syndrome, first described in 1757 by william hunter 1, refers to a constellation of clinical symptoms caused by obstruction of the svc. The syndrome is almost invariably secondary to a malignant process. 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. A 58yearold man presents with a 2week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. The superior vena cava syndrome, which occurs in approximately 15,000 persons in the united states. Because the superior vena cava svc is located within the narrow space of the mediastinum, any intraluminal or extraluminal compression impairs venous drainage and results. Superior vena cava syndrome is diagnosed by ultrasound, chest xray, ct scan, and in some cases biopsy. An intrathoracic malignancy is responsible for 60 to 85 percent of cases of superior vena cava syndrome svc syndrome, and. It transports blood from our arms, chest, neck, and head to our hearts. The last line of the paragraph under the surgery heading page 1867 should have read a curative approach generally involves preoperative chemotherapy, surgical resection and reconstruction.
The photograph shows massive engorgement of collateral subcutaneous veins of the chest and abdomen in a 58yearold man with partial obstruction of the superior vena. You can find a useful overview of many oncologic emergencies here. A 52yearold man with coronary arteriovenous fistula between left coronary artery and superior vena cava was reported. Superior vena cava syndrome with malignant causes clinical practice, n engl j med 2007. Although rarely fatal, may sometimes present as lifethreatening upper airway ob. Find the right keywords or related words and phrases for your projects.