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VERIFIED CONTENTAuthor: lek. Łukasz Kujawa

Superior vena cava syndrome (SVCS) is a group of clinical symptoms classified as oncological emergencies, as it mostly affects patients with neoplastic growth in the thoracic region. The superior vena cava syndrome requires efficient diagnosis and immediate treatment with appropriate treatment.

Superior vena cava syndrome (SVCS) usually occurs with mediastinal hyperplasia that obstruct or prevent blood flow through the vena cava. The superior vein (VCS) is a large-caliber venous vessel. It arises from the junction of the brachiocephalic veins (left and right) and flows into the right atrium of the heart. It collects blood from the upper body - head, neck, upper chest. It runs within the right upper and middle mediastinum, in close proximity to extremely important organs and structures, including the right lung, trachea, right bronchus, aorta, pulmonary trunk and mediastinal lymph nodes.

Superior vena cava syndrome: causes

Symptoms of the syndrome result from obstructed flow through the superior vena cava. The most common (because it accounts for more than 80% of cases) is cancer - both its direct infiltration and the external pressure of the tumor on a thin-walled vessel. Cancerous causes are primarily:

  • lung cancer - the most common (70-80% of SVCS cases),
  • non-Hodgkin's lymphoma,
  • transfers to the above-mentioned lymphatic mediastinum.

Less frequent:

  • metastases of breast cancer,
  • germ cell tumors located in the mediastinum,
  • thymus,
  • Hodgkin's lymphoma,
  • pleural mesothelioma,
  • esophageal cancer,
  • thyroid cancer.

Less often, because in about 20% of cases, non-neoplastic causes may also be responsible for blockage of the outflow through the superior vena cava, such as:

  • thoracic aortic aneurysm,
  • venous thrombosis associated with the presence of a vascular catheter,
  • idiopathic mediastinal fibrosis,
  • fibrosis as a consequence of chronic mediastinitis,
  • tuberculosis,
  • benign tumorsmediastinum.

Superior Vena Cava Syndrome: Symptoms

The consequence of DVT is stasis and an increase in venous blood pressure in the area of ​​the upper body - above the stenosis. The most common symptoms are:

  • swelling of the face, neck and upper limbs;
  • bruising around the head and neck;
  • conjunctival redness;
  • excessive filling of the jugular veins.

In addition, patients may complain of ailments such as dizziness, headache and visual disturbances. In advanced cases, we can deal with severe dyspnea, hoarseness, stridor, chest pain, and even swallowing disorders. Ailments may intensify when lying down or in an inclined position.

The long-developing superior vena cava syndrome leads to the formation of collateral circulation - an alternative route of venous blood outflow to the heart. The clinical manifestation of this condition is visible dilated veins on the surface of the chest.

The most dangerous consequences of DVT include: brain edema, laryngeal edema and pulmonary embolism.

Superior Vena Cava Syndrome: Diagnostics

In a large proportion of cases, the diagnosis of superior vena cava syndrome is possible through a clinical examination, but additional diagnostic tests are necessary in the context of further management. Even a standard radiograph (X-ray examination) can reveal dilated mediastinum and the pleural effusion often accompanying the syndrome. However, much more information is provided by computed tomography (CT) examination, thanks to which it is possible to differentiate the cause, the exact location of the stenosis or the presence of thrombosis. Magnetic resonance imaging (MR) and venography are very good, but less often available.

When dealing with a neoplastic cause - histopathological examination is of great importance, especially when the superior vena cava syndrome was diagnosed before an accurate diagnosis was made. Determining the type of neoplasm is essential as it influences the type of treatment.

Superior Vena Cava Syndrome: Treatment

Management of DVT may be symptomatic or causal. Conservative treatment includes the administration of glucocorticosteroids (mainly dexamethasone) and diuretics. Their application may result in a short-term reduction of symptoms.

However, causal treatment is of key importance. Radiotherapy is the first-line treatment in patients with malignant superior vena cava syndrome. Irradiation to the mediastinum is particularly indicated and effective in patientspatients with known lung cancer (especially small cell cancer). Radiotherapy is usually given urgently, especially in cases where the onset is rapid.

Exceptionally, when the patient's condition is severe - irradiation can be performed without prior histopathological diagnosis. In the case of tumors, the so-called for chemosensitive (e.g. lymphoma) chemotherapy is the preferred treatment.

Palliative surgical procedures such as vascular access angioplasty combined with stent implantation or bypass grafting are used less frequently, especially in selected patients.

Superior vena cava syndrome: prognosis

Due to the risk of serious complications, superior vena cava syndrome is a medical emergency and requires urgent intervention. There are methods that allow you to relatively effectively reduce symptoms and improve the quality of life. Nevertheless, prognosis depends on the underlying disease if the syndrome has developed secondary to cancer. In the case of lung cancer, it indicates a significant advancement of the process and is an unfavorable prognostic factor.

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Category:

Cardiology