Abstract
Superior vena cava syndrome (SVCS) is the result of any condition that causes obstruction to blood flow. The clinical picture depends on the idiosyncrasies of the patient, location, and time of the obstruction. The diagnosis of SVCS is clinical and is complemented with testing such as computed tomography (CT) and radiography (X-ray) of the thorax. The causes of SVCS range from benign to malignant. However, malignant tumors represent 85–95% of cases with non-small cell lung cancer representing 50% of all malignant causes. SVCS is an oncological emergency; nonetheless, it is an uncommon complication. Each year 15,000 North Americans suffer from this condition, and 10% of patients with left hemithorax malignancies will develop SVCS. In SVCS, a venous obstruction of the superior portion causes increased venous pressure. This leads to a dilation of the superficial collateral veins; facial edema; conjunctival edema, with or without proptosis; and central nervous system (CNS) symptoms. Dyspnea is the most common symptom, followed by chest pain, cough, and stridor, among other signs. Cerebral edema can also be present which produces headache, confusion, and coma. Radiotherapy and chemotherapy continue being first-line treatments with a high success rate. However, the definitive treatment plan depends on the etiology of SVCS. Almost 20 years ago, a recommendation was made to conduct a randomized clinical trial on SVCS comparing particular treatment modalities; such a trial has not yet taken place. Much research is needed, in terms of classification, treatment, and management.
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References
Zimmerman S, Davis M. Rapid fire: superior vena cava syndrome. Emerg Med Clin N Am. 2018;36:577–84. https://doi.org/10.1016/j.emc.2018.04.011.
Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862–9. https://doi.org/10.1056/NEJMcp067190.
Aryana A, Sobota KD, Esterbrooks DJ, Gelbman AI. Superior vena cava syndrome induced by endocardial defibrillator and pacemaker leads. Am J Cardiol. 2007;99:1765–7. https://doi.org/10.1016/j.amjcard.2007.01.065.
Zisis C, Skevis K, Kefaloyannis EM, et al. Mediastinal tuberculous lymphadenitis presenting as superior vena cava syndrome. J Thorac Cardiovasc Surg. 2006;131:e11–2. https://doi.org/10.1016/j.jtcvs.2006.02.003.
Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85:37–42. https://doi.org/10.1097/01.md.0000198474.99876.f0.
Seligson MT, Surowiec SM. Superior Vena Cava Syndrome. [Updated 2019 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441981/.
Gupta V, Ambati SR, Pant P, Bhatia B. Superior vena cava syndrome in children. Indian J Hematol Blood Transfus. 2008;24:28–30. https://doi.org/10.1007/s12288-008-0020-0.
Yu JB, Wilson LD, Detterbeck FC. Superior vena cava syndrome – a proposed classification system and algorithm for management. J Thorac Oncol. 2008;3:811–4. https://doi.org/10.1097/JTO.0b013e3181804791.
Stanford W, Doty DB. The role of venography and surgery in the management of patients with superior vena cava obstruction. Ann Thorac Surg. 1986;41:158–63.
Wudel LJJ, Nesbitt JC. Superior vena cava syndrome. Curr Treat Options Oncol. 2001;2:77–91.
Lepper PM, Ott SR, Hoppe H, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care. 2011;56:653. https://doi.org/10.4187/respcare.00947.
Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database Syst Rev. 2001;CD001316. https://doi.org/10.1002/14651858.CD001316.
Wilson P, Bezjak A, Asch M, et al. The difficulties of a randomized study in superior vena caval obstruction. J Thorac Oncol. 2007;2:514–9. https://doi.org/10.1097/JTO.0b013e318060096b.
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Matos, V.J. (2020). Superior Vena Cava Syndrome in Critically Ill Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_114
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DOI: https://doi.org/10.1007/978-3-319-74588-6_114
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