Superior vena cava syndrome - Revision history

Rossdonaldson1: /* Clinical Features */

2022-01-08T04:47:50Z

Clinical Features

← Older revision		Revision as of 04:47, 8 January 2022
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	==Clinical Features==		==Clinical Features==
			[[File:PMC4962438 12886 2016 301 Fig1 HTML.png\|thumb\|SVC syndrome with classic symptoms, including obvious face, neck, and upper trunk swelling.]]
	*[[Facial swelling]]		*[[Facial swelling]]
	**Worse in morning, gets better as day progresses		**Worse in morning, gets better as day progresses

Rossdonaldson1: /* Background */

2022-01-08T04:31:31Z

Background

← Older revision		Revision as of 04:31, 8 January 2022
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	==Background==		==Background==
			[[File:Gray505.png\|thumb\|SVC anatomy.]]
	*External compression by extrinsic malignant mass causes majority of cases		*External compression by extrinsic malignant mass causes majority of cases
	*Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause		*Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause

ClaireLewis at 18:37, 1 October 2019

2019-10-01T18:37:22Z

← Older revision		Revision as of 18:37, 1 October 2019
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	*External compression by extrinsic malignant mass causes majority of cases		*External compression by extrinsic malignant mass causes majority of cases
	*Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause		*Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause
	*~~Infection~~		*Other causes include benign tumors, aortic aneurysm, infections, and fibrosing mediastinitis<ref> Nickloes TA, Lopez Rowe V, Kallab AM, Dunlap AB (28 March 2018). "Superior Vena Cava Syndrome". ''Medscape''</ref>
	*Rarely constitutes an emergency		*Rarely constitutes an emergency
	**Gradual process; collaterals dilate to compensate for the impaired flow		**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		**Exception is neurologic abnormalities due to [[increased ICP]], laryngeal edema causing [[stridor]], [[shock\|decreased cardiac output]]

	===Risk Factors===		===Risk Factors===
	*Lung Cancer		*Lung Cancer
	*Lymphoma		*[[Lymphoma]]
	*Indwelling vascular catheters (increasing incidence)		*Indwelling vascular catheters (increasing incidence)
	*~~Thrombotic coagulopathy~~		*Thrombophilia
	*Goiter		*[[thyroid\|Goiter]]
	*TB		*[[TB]]
	*Radiation		*Radiation
	*Pericardial constriction		*Pericardial constriction
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	*Telangiectasia		*Telangiectasia
	*Neurologic abnormalities (rare)		*Neurologic abnormalities (rare)
	**Visual changes		**[[visual disturbances\|Visual changes]]
	**[[Dizziness]]		**[[Dizziness]]
	**Confusion		**[[Confusion]]
	**[[Seizure]]		**[[Seizure]]
	**[[Syncope]]		**[[Syncope]]
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	**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)		**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)
	*[[CXR]]		*[[CXR]]
	**Shows mediastinal mass or ~~paranchymal~~ lung mass (10% of patients)		**Shows mediastinal mass or parenchymal lung mass (10% of patients)

	==Management==		==Management==
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	**Mediastinal radiation, consult oncology/radiation oncology		**Mediastinal radiation, consult oncology/radiation oncology
	*If thrombus		*If thrombus
	**Anticoagulation, catheter removal, consider thrombolytics		**[[Anticoagulation]], catheter removal, consider [[thrombolytics]]

	==Disposition==		==Disposition==

Kxl328: /* Management */

2019-04-28T19:40:04Z

Management

← Older revision		Revision as of 19:40, 28 April 2019
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	*If thrombus		*If thrombus
	**Anticoagulation, catheter removal, consider thrombolytics		**Anticoagulation, catheter removal, consider thrombolytics

			==Disposition==
			*Admit to ICU, with plan for airway monitoring and tissue biopsy

	==References==		==References==

Kxl328: /* Management */

2019-04-28T19:39:23Z

Management

← Older revision		Revision as of 19:39, 28 April 2019
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	*Use IVs placed in lower extremities to avoid further SVC venous congestion<ref>Chaudhary K, Gupta A, Wadhawan S, Jain D, Bhadoria P. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2016 Jul 19];28:242-6. Available from: http://www.joacp.org/text.asp?2012/28/2/242/94910.</ref>		*Use IVs placed in lower extremities to avoid further SVC venous congestion<ref>Chaudhary K, Gupta A, Wadhawan S, Jain D, Bhadoria P. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2016 Jul 19];28:242-6. Available from: http://www.joacp.org/text.asp?2012/28/2/242/94910.</ref>
	*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>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.</ref>		*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>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.</ref>
	*Intravascular stent		*Intravascular stent, consult IR
	*If malignancy		*If malignancy
	**Mediastinal radiation		**Mediastinal radiation, consult oncology/radiation oncology
	*If thrombus		*If thrombus
	**Anticoagulation, catheter removal, consider thrombolytics		**Anticoagulation, catheter removal, consider thrombolytics

Modanq: Added HA

2017-11-05T03:22:29Z

Added HA

← Older revision		Revision as of 03:22, 5 November 2017
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	*[[Facial swelling]]		*[[Facial swelling]]
	**Worse in morning, gets better as day progresses		**Worse in morning, gets better as day progresses
			*[[Headache]]
	*[[Cyanosis]]		*[[Cyanosis]]
	*[[Dyspnea]]		*[[Dyspnea]]

Neil.m.young at 16:40, 1 March 2017

2017-03-01T16:40:25Z

← Older revision		Revision as of 16:40, 1 March 2017
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	==Evaluation==		==Evaluation==
	[[File:SVC_syndrome.jpg\|thumb\|CT chest showing ~~rightlung~~ tumor compressing SVC]]		[[File:SVC_syndrome.jpg\|thumb\|CT chest showing right lung tumor compressing SVC]]
	*CT with IV contrast		*CT with IV contrast
	**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)		**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)

Neil.m.young: Text replacement - " R " to " right"

2017-02-27T21:44:00Z

Text replacement - " R " to " right"

← Older revision		Revision as of 21:44, 27 February 2017
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	==Evaluation==		==Evaluation==
	[[File:SVC_syndrome.jpg\|thumb\|CT chest showing ~~R lung~~ tumor compressing SVC]]		[[File:SVC_syndrome.jpg\|thumb\|CT chest showing rightlung tumor compressing SVC]]
	*CT with IV contrast		*CT with IV contrast
	**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)		**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T04:40:13Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:40, 26 July 2016
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	{{Oncologic emergencies DDX}}		{{Oncologic emergencies DDX}}

	==~~Diagnosis~~==		==Evaluation==
	[[File:SVC_syndrome.jpg\|thumb\|CT chest showing R lung tumor compressing SVC]]		[[File:SVC_syndrome.jpg\|thumb\|CT chest showing R lung tumor compressing SVC]]
	*CT with IV contrast		*CT with IV contrast

Kxl328 at 21:53, 19 July 2016

2016-07-19T21:53:11Z

← Older revision		Revision as of 21:53, 19 July 2016
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	*Elevate head of bed		*Elevate head of bed
	*Assess for and treat [[elevated intracranial pressure]]		*Assess for and treat [[elevated intracranial pressure]]
			*Use IVs placed in lower extremities to avoid further SVC venous congestion<ref>Chaudhary K, Gupta A, Wadhawan S, Jain D, Bhadoria P. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2016 Jul 19];28:242-6. Available from: http://www.joacp.org/text.asp?2012/28/2/242/94910.</ref>
	*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>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.</ref>		*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>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.</ref>
	*Intravascular stent		*Intravascular stent