Superior vena cava syndrome: Difference between revisions

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==Pathophysiology==
==Background==
#Occurs in 3-8%  with lung cancer and lymphoma
#External compression by extrinsic malignant mass causes majority of cases
#Symptoms due to venous hypertension in areas drained by SVC
#Rarely constitutes an emergency
#Deaths occurs from cerebral edema, airway compromise, or cardiac compromise
##Gradual process; collaterals dilate to compensate for the impaired flow
##Exception is neurologic abnormalities due to increased ICP
#Risk Factors:
##Lung Cancer
##Lymphoma
##Indwelling vascular catheters


==Clinical features==
==Clinical Features==
#Thoracic or neck vein distention - 65%
#Facial swelling
#Shortness of breath - 50%
#Dyspnea
#Tachypnea - 40%
#Cough
#Upper trunk or extremity edema - 40%
#Arm swelling
#Cough/dysphagia/chest pain - 20%
#Distended neck/chest wall veins
#Peri-orbital or facial edema - ?
#Neurologic abnormalities (rare)
#Stroke's sign (tight shirt collar) - ?
##Visual changes
##Dizziness
##Confusion
##Seizure


==Diagnosis==
==Diagnosis==
#CXR shows mediastinal mass or paranchymal lung mass in 10%
#CT w/ IV contrast
#CT is diagnostic
##Recommended imaging modality (assesses patency of the SVC)
#CXR
##Shows mediastinal mass or paranchymal lung mass (10% of pts)


==Management==
==Treatment==
#Furosemide 40mg IV
#Elevate head of bed
#Methylprednisolone 1-2 mg/kg IV
#Corticosteroids
##Effective if pt has steroid-responsive malignancy (e.g. lymphoma, thymoma)
#Loop diuretic
##?efficacy
#Mediastinal radiation
#Mediastinal radiation
#Intravascular stent


===Source===
===Source===
Sotelo 10/09
Tintinalli


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Revision as of 00:55, 23 October 2011

Background

  1. External compression by extrinsic malignant mass causes majority of cases
  2. Rarely constitutes an emergency
    1. Gradual process; collaterals dilate to compensate for the impaired flow
    2. Exception is neurologic abnormalities due to increased ICP
  3. Risk Factors:
    1. Lung Cancer
    2. Lymphoma
    3. Indwelling vascular catheters

Clinical Features

  1. Facial swelling
  2. Dyspnea
  3. Cough
  4. Arm swelling
  5. Distended neck/chest wall veins
  6. Neurologic abnormalities (rare)
    1. Visual changes
    2. Dizziness
    3. Confusion
    4. Seizure

Diagnosis

  1. CT w/ IV contrast
    1. Recommended imaging modality (assesses patency of the SVC)
  2. CXR
    1. Shows mediastinal mass or paranchymal lung mass (10% of pts)

Treatment

  1. Elevate head of bed
  2. Corticosteroids
    1. Effective if pt has steroid-responsive malignancy (e.g. lymphoma, thymoma)
  3. Loop diuretic
    1. ?efficacy
  4. Mediastinal radiation
  5. Intravascular stent

Source

Tintinalli

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