Superior Vena Caval Obstruction Flashcards
what are the most common causes of SVCO
malignant causes
- bronchogenic carcinoma (typically small cell lung cancer)
- lymphoma
- met tumours (renal, germ cell)
what are some rarer causes of SVCO
benign causes
- SVC thrombosis
- mediastinal fibrosis
what will be noted in the history
facial swelling/feeling of fullness in the head - worse after waking up, less by the end of the day
arm swelling
dysphagia/dyspnea (may coexist due to mediastinal compression)
other features of malignancy
on examination
distention of neck and chest wall veins fixed (ie non-pulsatile) elevated JVP facial oedema/puffiness oedema of the arms plethora of the face (redness due to increased blood) peripheral cyanosis Pembertons sign other signs of malignancy
what is pembertons sign
manoeuvre to demonstrate latent pressure in the thoracic inlet
patient elevated with arms until they touch the sides f the face
- a positive sign is marked by facial congestions (redness) and cyanosis with resp distress after ~ 1 minute
what investigations should be carried out
new presentation - staging biopsy prior to therapy
known malignancy - CXR, CT, superior venocavogram, bronchoscopy is lung primary suspected
what are the groups of management
steroids and supportive radiotherapy chemotherapy stunting of SVC thrombolysis and anticoagulation if SCVO due to thrombosis o SVC
what steroids/supportive management can be given
high dose CCS - dexamethasone 8mg bd (+gastroprotection and daily BM)
encourage patient to sit up in bed (oedema may be worse when lying flat)
what determines what radiotherapy/chemotherapy is used
tumour type (chemo/radiosensitive)
prior treatment
extent of disease elsewhere
when is stenting used
for recurrent SCVO or for benign causes
how do you manage catheter induces SVC thrombosis
remove catheter
thrombolysis
anticoagulation
