Superior vena cava syndrome: Difference between revisions
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==Background== | ==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 | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Facial swelling]] | |||
*[[Dyspnea]] | |||
*[[Cough]] | |||
*[[Arm swelling]] | |||
*Distended neck/chest wall veins | |||
*Neurologic abnormalities (rare) | |||
**Visual changes | |||
**[[Dizziness]] | |||
**Confusion | |||
**[[Seizure]] | |||
==Diagnosis== | ==Diagnosis== | ||
*CT w/ 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== | |||
==Treatment== | ==Treatment== | ||
*Elevate head of bed | |||
*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>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.</ref> | |||
*Intravascular stent | |||
*If malignancy | |||
**Mediastinal radiation | |||
*If thrombus | |||
**Anticoagulation, catheter removal, consider thrombolytics | |||
==Source== | ==Source== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 14:30, 14 January 2015
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
Clinical Features
- Facial swelling
- Dyspnea
- Cough
- Arm swelling
- Distended neck/chest wall veins
- Neurologic abnormalities (rare)
Diagnosis
- CT w/ 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
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
Source
- ↑ 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.