Makindo Medical Notes.com

Related Subjects: |Hypercalcaemia |Neutropenic Sepsis |Pulmonary Embolism |Lung Cancer |Superior vena caval obstruction syndrome |Cerebral Metastases |Metastatic bone disease |Oncological emergencies

Superior vena caval obstruction syndrome develops in 5-10% of patients with right-side malignant intrathoracic mass lesions.

About

• Obstruction of the superior vena cava

Aetiology

• 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

Causes

• 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

Clinical

• Facial swelling, dyspnoea, and cough
• Tracheal obstruction, Dilated neck veins
• Collateral veins on the anterior chest wall
• Worse when arms elevated above the head

Investigations

• 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

Pathology

• Malignancy

Management

• 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 and lymphoma.
• 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.

References