Superior vena cava syndrome: Difference between revisions
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##Mediastinal radiation | ##Mediastinal radiation | ||
#If thrombus | #If thrombus | ||
#Anticoagulation, catheter removal, consider thrombolytics | ##Anticoagulation, catheter removal, consider thrombolytics | ||
===Source=== | ===Source=== |
Revision as of 08:04, 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, evaluate etiology mass vs. thrombus)
- 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
- Intravascular stent
- If malignancy
- Mediastinal radiation
- If thrombus
- Anticoagulation, catheter removal, consider thrombolytics
Source
Tintinalli, Emedicine, Rosen's