Superior vena cava syndrome: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
Neil.m.young (talk | contribs) No edit summary |
||
| Line 16: | Line 16: | ||
*Radiation | *Radiation | ||
*Pericardial constriction | *Pericardial constriction | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 45: | Line 33: | ||
**[[Syncope]] | **[[Syncope]] | ||
**[[Papilledema]] and [[elevated ICP]] | **[[Papilledema]] and [[elevated ICP]] | ||
==Differential Diagnosis== | |||
{{Facial swelling DDX}} | |||
{{Oncologic emergencies DDX}} | |||
==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) | |||
==Management== | ==Management== | ||
Revision as of 00:10, 22 February 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 (increasing incidence)
- Thrombotic coagulopathy
- Goiter
- TB
- Radiation
- Pericardial constriction
Clinical Features
- Facial swelling
- Worse in morning, gets better as day progresses
- Cyanosis
- Dyspnea
- Cough
- Arm swelling
- Distended neck/chest wall veins
- Telangiectasia
- Neurologic abnormalities (rare)
- Visual changes
- Dizziness
- Confusion
- Seizure
- Syncope
- Papilledema and elevated ICP
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
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)
Management
- Elevate head of bed
- Assess for and treat elevated intracranial pressure
- 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.