Download Superior Vena Cava Syndrome in Emergency Rooms

Superior Vena Cava Syndrome in Emergency Rooms
Eren, G. University Ege, Medical School. Turkey.
Introduction
Superior vena cava syndrome (SVCS), which is easy to diagnose, develops as a result of
obstruction of the superior vena cava by:
* extrinsic compression
* direct invasion
* thrombus.
Origin
Primary intrathoracic malignancies account 87% - 97% for SVCS. Lung cancer is the most
common, followed by lymphoma and breast cancer. Iatrogenic causes are the most common
benign reasons and the incidence is increasing. The majority of iatrogenic cases result from
long term central venous catheters.
Symptomatology
The patiens suffer from dyspnoea, head fullness, cough, arm swelling, chest pain, and
dysphagia. Physical findings are: venous distension of the neck, venous distension of the
chest wall, facial oedema, cyanosis, pleathora of the face, oedema of the arms.
Diagnosis
History, physical examintation, chest X-Ray, thorax CT, MRI, bronchoscopy,
mediastinoscopy.
Treatment
Oxygen with nebulizator, diuretics, steroids, chemotherapy, radiotherapy, antikoagulans
(patients with catheter complication), stenting, surgery (mostly in benign disorders).
Treatment is directed at the underlying reason. Radiotherapy and chemotherapy are basic
treatments. If urgent radiotherapy is to be made it is important to determine whether
curation or palliation is aimed.
After externation, elective patients could be suggested alternative treatments such as herbal
remedies, hypnosis, aromatherapy, acupuncture, hydrotherapy, and massage among many
others.
Prevention
SVCS may be prevented by early treatment based on the etiology of cancer to slow down
the progression of malignancies. Iatrogenic catheter trombosis in SVC is also preventible.
Summary
SVCS is an oncological emergency that causes mortality and morbidity but it is easy to
diagnose and manage.
References
* Internal Medicine Text Book Ege
University, Dr.Ulus Ali Þanlý, page 412
* Gale Encyclopedia of Medicine, 2002
Summer School Participant
Gulnihan Eren
Izmir, Turkey
[email protected]
Acknowledgments
I would like to thank Dr. Mahmut Tobu
(Hematology Department) and Dr. Erhan
Gökmen (Oncology Department), Ege
University.