CURRENT Essentials of Critical Care.pdf

Chapter 19 Oncology/Oncologic Emergencies 281■■■Superior Vena Cava (SVC) SyndromeEssentials of Diagnosis• Compression, invasion, or thrombosis of SVC; most commonlycaused by malignancy• Headache, dizziness, sensation of fullness in head• Distention of neck and anterior chest wall veins• Facial plethora and edema• Cyanosis and edema of upper extremities• Dyspnea may occur from airway compression• Diagnosis made on clinical grounds in majority of cases• Chest radiographs, tomography, CT scans define extent of mediastinalinvolvement• Tissue diagnosis needed to establish etiology and guide therapeuticoptions• Etiologies: malignancy with lung cancer and lymphoma mostcommon; benign causes include aortic aneurysm, fibrosing mediastinitis,tuberculosis, pyogenic infection, radiation changes;thrombotic complications from intravascular cathetersDifferential Diagnosis• Angioedema • Thyroid goiter• Histoplasmosis • Syphilitic aneurysm of aorta• Upper extremity deep vein thrombosisTreatment• Chemotherapy treatment of choice for small cell lung cancer,lymphoma, germ cell tumors• Radiation therapy only option for all other tumors• Symptom relief measures: elevating head of bed, oxygen• Secure patency of airway with stents if needed to prevent trachealcompression• Corticosteroids may help decrease edema and secondary inflammatoryreaction• Saphenous vein bypass grafting useful in selected patients• Diuretics, anticoagulants, thrombolytic agents are of little helpand may actually be dangerous■ PearlMortality is related to the underlying malignancy rather than the presenceof superior vena caval obstruction.ReferenceMarkman M: Diagnosis and management of superior vena cava syndrome.Cleve Clin J Med 1999;66:59. [PMID: 9926632]