Cardiovascular Medicine Book

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Superior Vena Cava Obstruction

Aka: Superior Vena Cava Obstruction, Superior Vena Cava Syndrome
  1. Pathophysiology
    1. Superior Vena Cava Obstruction to flow
      1. Mediastinal mass compressing superior vena cava
      2. Vena cava thrombosis
    2. Azygous vein may provide some collateral drainage
  2. Causes
    1. Malignancy
      1. Bronchogenic Carcinoma (80%)
      2. Malignant Lymphoma (15%)
      3. Metastatic Disease
        1. Breast adenocarcinoma
        2. Testicular seminoma
    2. Benign Disease (Rare)
      1. Mediastinal fibrosis
        1. Idiopathic
        2. Histoplasmosis
        3. Actinomycosis
        4. Tuberculosis
      2. Vena Cava thrombosis
        1. Idiopathic
        2. Behcet's Syndrome
        3. Polycythemia Vera
        4. Paroxysmal Nocturnal Hemoglobinuria
        5. Long-term venous catheters, shunts or Pacemakers
      3. Benign Mediastinal tumor
        1. Aortic aneurysm
        2. Dermoid tumor
        3. Goiter
        4. Sarcoidosis
  3. Symptoms
    1. Dyspnea (50%)
    2. Neck and facial swelling (40%)
    3. Swelling of trunk and upper extremities (40%)
    4. Choking sensation
    5. Head fullness or pressure sensation
    6. Headache
    7. Chest Pain
    8. Cough
    9. Lacrimation
    10. Dysphagia
  4. Signs
    1. Thoracic vein distention (65%)
    2. Neck vein distention (55%)
    3. Facial edema (55%)
    4. Tachypnea (40%)
    5. Plethora of the face and Cyanosis (15%)
    6. Edema of upper extremities (10%)
    7. Paralysis of Vocal Cords (3%)
    8. Horner's Syndrome (3%)
    9. Distended antecubital veins
  5. Associated Conditions
    1. Spinal Cord compression
  6. Radiology
    1. Chest XRay shows mass in 90%
      1. Right superior mediastinum (75%)
      2. Hilar Adenopathy (50%)
      3. Right Pleural Effusion (25%)
    2. Chest CT
  7. Management
    1. Identify mass etiology
    2. Supportive care
      1. ABC Management
      2. Corticosteroids
      3. Diuretics
      4. Elevate the head of the bed
    3. Reduction in mass size
      1. Radiation Therapy
      2. Chemotherapy
      3. Surgical decompression
    4. Consider Anticoagulation
    5. Intravenous stenting
  8. Prognosis
    1. Poor prognostic sign: Predicts 90% mortality in 3 years

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