Superior vena cava syndrome: Difference between revisions
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*Lymphoma | *Lymphoma | ||
*Indwelling vascular catheters | *Indwelling vascular catheters | ||
==Diagnosis== | |||
[[File:SVC_syndrome.jpg|thumb|CT chest showing R lung tumor compressing SVC]] | |||
*CT with IV contrast | |||
**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus) | |||
*[[CXR]] | |||
**Shows mediastinal mass or paranchymal lung mass (10% of pts) | |||
==Differential Diagnosis== | |||
{{Facial swelling DDX}} | |||
{{Oncologic emergencies DDX}} | |||
==Clinical Features== | ==Clinical Features== | ||
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**Confusion | **Confusion | ||
**[[Seizure]] | **[[Seizure]] | ||
==Treatment== | ==Treatment== | ||
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**Anticoagulation, catheter removal, consider thrombolytics | **Anticoagulation, catheter removal, consider thrombolytics | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 14:54, 21 January 2016
Background
- External compression by extrinsic malignant mass causes majority of cases
- Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause
- Infection
- Rarely constitutes an emergency
- Gradual process; collaterals dilate to compensate for the impaired flow
- Exception is neurologic abnormalities due to increased ICP, laryngeal edema causing stridor, decreased cardiac output
Risk Factors
- Lung Cancer
- Lymphoma
- Indwelling vascular catheters
Diagnosis
- CT with IV contrast
- Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)
- CXR
- Shows mediastinal mass or paranchymal lung mass (10% of pts)
Differential Diagnosis
Facial Swelling
- Buccal space infections
- Dental problems
- Canine space infection
- Facial cellulitis
- Herpes zoster
- Masticator space infections
- Maxillofacial trauma
- Neoplasm
- Parapharyngeal space infection
- Salivary gland diagnoses
- Parotitis
- Ranula
- Sialoadenitis
- Sialolithiasis
- Superior vena cava syndrome
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Clinical Features
- Facial swelling
- Worse in morning, gets better as day progresses
- Cyanosis
- Dyspnea
- Cough
- Arm swelling
- Distended neck/chest wall veins
- Neurologic abnormalities (rare)
Treatment
- Elevate head of bed
- Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team[1]
- Intravascular stent
- If malignancy
- Mediastinal radiation
- If thrombus
- Anticoagulation, catheter removal, consider thrombolytics
References
- ↑ McCurdy M et al. Oncologic emergencies, part I: spinal cord compression, superior vena cava syndrome, and pericardial effusion. Emergency Medicine Practice. 2010; 12(2):7-10.