Superior vena cava syndrome: Difference between revisions
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==Background== | ==Background== | ||
#External compression by extrinsic malignant mass causes majority of cases | #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 | #Rarely constitutes an emergency | ||
##Gradual process; collaterals dilate to compensate for the impaired flow | ##Gradual process; collaterals dilate to compensate for the impaired flow | ||
##Exception is neurologic abnormalities due to increased ICP | ##Exception is neurologic abnormalities due to increased ICP, laryngeal edema causing stridor, decreased cardiac output | ||
#Risk Factors: | #Risk Factors: | ||
##Lung Cancer | ##Lung Cancer |
Revision as of 07:57, 8 March 2012
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)
- CXR
- Shows mediastinal mass or paranchymal lung mass (10% of pts)
Treatment
- Elevate head of bed
- Corticosteroids
- Effective if pt has steroid-responsive malignancy (e.g. lymphoma, thymoma)
- Loop diuretic
- Questionable efficacy
- Mediastinal radiation
- Intravascular stent
Source
Tintinalli