| Neutropenic Sepsis
| Pulmonary Embolism
| Superior vena caval obstruction syndrome
| Cerebral Metastases
| Metastatic bone disease
| Oncological emergencies
Superior vena caval obstruction syndrome develops in 5-10% of patients with a right-side malignant intrathoracic mass lesions.
- Obstruction of the superior vena cava
- Causes obstruction of venous return from neck and head and arms
- SVC has a thin wall and because there is little pressure inside the vein, it can be easily compressed by outside structures.
- Lies next to the upper lobe of the right lung and within the mediastinum
- 85% are due to lung cancer or other malignancy
- Lung cancer or Lymphoma
- Thrombosis from venous catheters, pacemakers, PICC lines
- Mediastinal fibrotic diseases
- Aortic aneurysm or AV fistula
- Histoplasmosis, TB, Syphilis
- Children - non-Hodgkin's lymphoma
- Facial swelling, dyspnoea, and cough
- Tracheal obstruction, Dilated neck veins
- Collateral veins on the anterior chest wall
- Worse when arms elevated above the head
- FBC, U&E, LFTS, CRP, Calcium, ALP
- Chest x-ray (CXR) may show widening
the superior mediastinum; 25% of pts have a right-sided pleural effusion.
- Sputum cytologic
- CT scan is diagnostic and can be used for taking biopsies
- Invasive contrast venography is the most conclusive diagnostic tool
- ABC, Oxygen, Sit up, Steroids may be considered
- Radiation therapy is the treatment of choice for non-small-cell lung cancer
- Chemotherapy added to radiation therapy is effective in small-cell lung cancer
- Symptoms recur in 10-30% and can be palliated by venous stenting.
- Clotted central catheters producing this syndrome should be removed and
anticoagulation therapy initiated.