Superior vena cava syndrome: Difference between revisions
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==Source== | ==Source== | ||
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Tintinalli, Emedicine, Rosen's | Tintinalli, Emedicine, Rosen's | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] |
Revision as of 15:12, 10 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)
- Visual changes
- Dizziness
- Confusion
- Seizure
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)
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.
Tintinalli, Emedicine, Rosen's