All words related to superior vena cava syndrome from a to z. 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. 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. Lung cancer is the most common cause of superior vena cava syndrome svcs and requires timely recognition and management. A 52yearold man with coronary arteriovenous fistula between left coronary artery and superior vena cava was reported. Malignancyrelated superior vena cava syndrome uptodate. The treatment of choice is irradiation, but in resistant cases or in. Introduction superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. This simple keywords research tool will give you a list of the most popular keywords. The syndrome was originally described as being secondary to an infection, such as tuberculosis, or a syphilitic aortic aneurysm 24. This summary explains svcs and its treatment in adults and children. Lymph nodes that drain the entire right chest and lower portion of. 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 definition of superior vena.
Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or. San francisco, california nalthough the superior vena cava syndrome is a well. A 58yearold man presents with a 2week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. Superior vena cava syndrome an overview sciencedirect. Find the right keywords or related words and phrases for your projects. Superior vena cava syndromea proposed classification system and algorithm for management. Although rarely fatal, may sometimes present as lifethreatening upper airway ob. Superior vena cava syndrome discharge care what you. He was intubated and brought to the emergency department. 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. Review of evolving etiologies, implications and treatment. William hunter first described the syndrome in 1757 in a patient with syphilitic aortic aneurysm. The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper.
Superior vena cava syndrome svcs is a collection of symptoms that usually occur in patients who have lung cancer, nonhodgkin lymphoma, or other cancers. 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. 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. Review of evolving etiologies, implications and treatment strategies. Svcs is a significant disorder affecting up to 10 % of small cell lung cancer sclc patients and 24 % of all lung cancer patients. 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. Treatment should also be individualized and should not be undertaken until a. Superior vena cava syndrome svcs is an acute or subacute oncologic emergency with typical clinical features.
A computed tomographic pulmonary angiogram led to an initial diagnosis of leftsided superior vena cava and partial anomalous pulmonary venous drainage. Images in clinical medicine from the new england journal of medicine superior vena cava syndrome. The dialysis catheter, inserted into the left internal jugular vein under fluoroscopic guidance, showed a left superior vena cava draining into the. Images in clinical medicine from the new england journal of medicine superior vena cava. Symptoms include swelling of the face and arms associated with shortness of breath. 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. Pdf a 59yearold man with hypertension and crohns disease that was complicated by fistulas was found. Superior vena cava syndrome svcs is obstruction of blood flow through the superior vena cava svc. Diagnosis and management of superior vena cava syndrome. Superior vena cava syndrome secondary to aortic disease.
The superior vena cava is one of the primary veins within our bodies. Superior vena cava syndrome approach bmj best practice. In superior vena cava syndrome svcs, this vein has. Superior vena cava syndrome with malignant causes clinical practice, n engl j med 2007. 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. Appropriate imaging techniques are important to confirm the diagnosis and rule out other causes of svc syndrome. You can find a useful overview of many oncologic emergencies here. Historically, and in other parts of the world, infection syphilis and tuberculosis is another cause of superior vena cava syndrome.
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. Currently, svc syndrome is generally due to cancer or thrombotic events. The syndrome is rarely an oncologic emergency in the absence of tracheal compression and airway compromise. Superior vena cava syndrome is a pathological condition in which the superior vena cava gets obstructed or impinged. A patient with svcs requires immediate diagnostic evaluation and therapy. Know what is superior vena cava syndrome, its causes, symptoms, treatment and prognosis. 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. A 59yearold man with hypertension and crohns disease that was complicated by fistulas was found unconscious at home. 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. See next steps if you are interested in a career in oncology and are looking for more resources and information on conferences. Superior vena cava svc syndrome is the result of stenosis or occlusion of the svc or bilateral brachiocephalic veins. It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax. A case of malignant superior vena cava syndrome presenting. The primary reason behind this compression or impingement is believed to be malignant tumors especially of the lungs.
The syndrome is almost invariably secondary to a malignant process. The superior vena cava syndrome, which occurs in approximately 15,000 persons in the united states. Venography showed occlusion of the superior vena cava. He was cyanotic and had finger clubbing with oxygen saturation of 85% to 90%. Superior vena cava svc syndrome results from any condition that leads to obstruction of blood flow through the svc.
Superior vena cava syndrome with malignant causes nejm. The right and left brachiocephalic veins join to form the svc. Symptoms of the syndrome include shortness of breath. 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. 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. The patient with superior vena cava syndrome might complain of headache, dysphagia, hoarseness, or shortness of breath. Description superior vena cava syndrome is a partial occlusion of the. Stridor, facial and arm swelling, headache and cough in a patient with metastatic nsclc are not solely manifestations of svc syndrome. Superior vena cava syndromea proposed classification system and algorithm. Treatment depends on the etiology of the obstructive process. Clinical condition that occurs due to obstruction of the superior vena cava.
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. A 42yearold man presented to his local hospital with sepsis. Superior vena cava svc syndrome occurs in approximately 15,000 people in the united states each year. Contrastenhanced computed tomographic imaging of the chest revealed a markedly compressed superior vena cava svc. 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 syndromecausessymptomstreatment. He was admitted to our hospital for chest pain, but had no murmur. Superior vena cava syndrome in thoracic malignancies. The clinical diagnosis of svc syndrome is based largely on history and physical examination.
An intrathoracic malignancy is responsible for 60 to 85 percent of cases of superior vena cava syndrome svc syndrome, and. 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. Superior vena cava syndrome svcs is a relatively common sequela. In the event of svc obstruction, venous pressure in collateral vessels. Superior vena cava syndrome svcs develops when your superior vena cava is partially or fully blocked.
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. Nonsmall cell lung cancer nsclc is the most common malignant cause of svc syndrome, accounting. The patient also had distended neck veins but minimal facial edema. One was lack of or decreased opacification of central venous structures distal to the site of obstruction. A case of malignant superior vena cava syndrome presenting as. 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 become obstructed or compressed to some degree. Malignant obstruction of the superior vena cava nejm. Svc syndrome is extrinsic or intrinsic obstruction of blood flow through the svc, leading to proximal congestion. It transports blood from our arms, chest, neck, and head to our hearts. Superior vena cava syndrome is diagnosed by ultrasound, chest xray, ct scan, and in some cases biopsy. Chronic occlusion of the superior vena cava resulting in.
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