Intrathoracic goitre: A cause of the superior vena cava syndrome

Benign lesions of the mediastinum rarely produce obstruction of the innominate vessels. Two patients with intrathoracic goitre are described who presented with the superior vena cava syndrome. Venography in each case demonstrated the extent of obstruction and degree of collateral circulation. Early recognition of the association of intrathoracic goitre and superior vena caval obstruction may lead to clinical improvement with surgical treatment.     

Congenital left superior vena cava with absent right superior vena cava: a cause of progressive mediastinal widening

We wish to report a patient with the rare anomaly of congenital left superior vena cava and absent right superior vena cava. This became apparent on chest radiographs by the development of a left mediastinal "mass" over a one-year period. The role of contrast-enhanced computed tomographic scanning in the detection of venous anomalies is stressed.     

The vena cava superior syndrome in sarcoidosis

We report the first observation of clinical manifestations of vena cava superior syndrome (VCSS) associated with sarcoidosis. Twenty-four years after the first signs of the disease had been noted, mediastinal lymphomas penetrating the wall of the vena cava superior caused complete obstruction. It is most unusual for the vessel wall to be destroyed in this way, which explains why VCSS is often missed in sarcoidosis. The obstructed vessel was resected and successfully replaced by a Gore-Tex prosthesis. The importance of VCSS for the differential diagnosis is pointed out. Two further peculiarities are the simultaneous occurrence of elevated intraocular pressure and VCSS, and the familial incidence.     

Emergency computed tomography in the diagnosis of superior vena cava syndrome

Superior vena cava syndrome (SVCS) presents with a number of nonspecific symptoms that must be assessed rapidly to prevent life-threatening sequelae such as cerebral edema and respiratory failure. To define the utility of computed tomography (CT) in evaluating SVCS, we initiated a retrospective analysis of all emergent chest CT scans performed at our affiliated institutions to rule out SVCS. Twenty-eight emergent chest CT scans were analyzed. In all 23 cases confirmed to have SVCS (true-positives), CT depicted the nature and extent of the obstructing lesions. In 4 of 5 symptomatic cases (80%) proven not to have SVCS, CT imaged the abnormalities responsible for the misleading clinical appearance. CT also outlined the extent and course of superficial chest wall venous collaterals in all 23 true-positive cases and that of mediastinal collaterals in 18 cases. We also found 12 patients to have CT evidence of soft tissue edema of the upper thorax, an indicator of SVCS not previously detailed. A large number of related, unsuspected lesions were also identified. Our study supports the emergent use of chest CT as the imaging modality of choice in the work-up of patients presenting with the clinical suspicion of SVCS.     

Treatment of the superior vena cava syndrome

The author describes the results of therapy in three groups of patients (128 patients altogether) with the superior vena cava syndrome caused by a tumorous disease. All the patients were treated by radiotherapy as a main method of therapy. (200 kV, filtration 2 mm Cu) in a daily fractionation 300 r on the surface by one field, in the second period (1974-1978) 55 patients were irradiated by 60Co cobalt from two opposite fields by daily fractionation of 170-180 rad into the focus and in the third period (1984-1986) 25 patients were irradiated by 60Co cobalt from two opposite fields in 3-4 introductory daily fractions 3.0 Gy into the focus and then in normal fractionation up to the total dose planned. Immediate results of the treatment--complete disappearance of the syndrome symptoms--were the best in the 3rd group, where a complete disappearance of the symptoms was observed in 84% of patients and a partial relief in 8%. In the first period a complete disappearance of symptoms was in 54% and a partial relief in 10% of patients. The corresponding values in the second period were 74% and 11% respectively. In evaluating the survival of patients, no significant differences were found. In the first period, 50% of patients survived 12 weeks, in the second period 16 weeks and in the third one 20 weeks. One-year survival was reached by two per cent of patients in the first period, four per cent in the second period and eight per cent in the third period. The paper discusses other therapeutic possibilities and approaches in the treatment of the superior vena cava syndrome.     

上腔静脉综合征支架植入术后并发症分析

目的 探讨上腔静脉综合征(SVCS)支架植入术的并发症及其影响因素,以便制定合理的预防和处理措施.方法 对39例不同原因所致的SVCS患者的临床资料进行回顾性分析.39例患者均行静脉造影,明确上腔静脉狭窄位置、程度、范围,然后行上腔静脉支架植入术.支架植入后以狭窄程度<50%或狭窄程度减少20%以上,同时患者症状在治疗后短期缓解作为支架植入有效的标准,观察术后并发症情况.结果 39例共植入支架40枚.术后35例患者症状明显好转,有效率89.7%(35/39).6例发生并发症,发生率15.4%,其中1例因术后化疗有效、病变缩小致支架移位,症状未加重而未予处理;1例因未抗凝等后续治疗导致血栓形成,后行溶栓及放射治疗致支架移位,患者自动出院;1例因植入大网眼Gianturco Z形支架,肿瘤向网眼内生长导致再狭窄,患者自动出院;急性肺梗死及急性右心功能不全各1例,内科保守治疗后症状缓解;急性心包积液1例,急诊行心包抽液后症状缓解.结论 SVCS支架植入术并发症种类较多,部分后果严重.需根据病因选择合适的治疗方法和合适的支架型号,术中操作轻柔仔细,重视术后处理等方能有效减少并发症.     

Lipomatous hypertrophy presenting as superior vena cava syndrome

We report a rare case of invasive lipomatous hypertrophy of the interatrial septum presenting as superior vena cava syndrome requiring surgical resection. Lipomatous hypertrophy of the interatrial septum is a common incidental finding and is thought to be a relatively benign condition. Classically, its appearance on cardiac computed tomography is primarily fatty with low attenuation, sharp margins and minimal enhancement, involving the interatrial septum with relative sparing of the fossa ovalis. In masses of unclear etiology or in rare, extensive cases resulting in cavity obstruction, such as ours, cardiac computed tomography provides complementary information to define tumor extent and characterize classic mass features facilitating diagnosis and management.     

The superior vena cava syndrome as an emergency in radiotherapy

Between 1983 and 1988 90 patients with bronchial neoplasms needed emergency irradiation to treat superior vena cava syndrome. Pathohistologically verified were 30 cases with squamous cell carcinoma, twelve with adenocarcinoma, five cases with large cell carcinoma, 30 with a small cell carcinoma, and non-differentiated in five others. No histological examination was carried out in eight cases. Im 30 patients distant metastases were evident at the initial diagnosis. The average duration of follow-up was 118 days. The survival course proved to be independent of histopathological grading, previous treatment, and age. Similarly no influence of the fractionation employed could be seen. Very important to the prognosis however, were the stage of disease, the Karnofsky index, and dependent on that, the total reference dose applied. Patients with a Karnofsky index of 50% or lower survived on average only 17 days.     

先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗

目的 探讨先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗方法。方法 手术治疗2例,在全麻体外循环下行矫治术。1例采用左上腔静脉直接插管法,1例采用心内冠状静脉窦插管法。结果 2例均治愈,远期无心律失常发生。结论 先天性心脏病中,左上腔静脉合并右上腔静脉缺如非常少见,认识不足,是造成漏诊的主要原因。术中应根据情况酌情处理,但无论采取哪种方法,一定要注意对冠状静脉窦口的保护及左上腔静脉引流的通畅。     

肺癌合并上腔静脉综合征的介入治疗

目的探讨经皮血管内支架植入联合肿瘤供血动脉化疗栓塞治疗肺癌合并上腔静脉综合征的方法及临床价值。方法28例肺癌合并上腔静脉阻塞患者,经螺旋CT和静脉造影明确诊断,以阻塞远侧静脉压大于22mmHg为支架植入适应证,支架植入前明确伴有继发血栓形成患者行抗凝及溶栓治疗,经肘前静脉或股静脉入路,先行狭窄部位球囊扩张术,然后在上腔静脉和头臂静脉狭窄段植入支架,支架植入前后联合支气管动脉栓塞化疗。结果28例患者成功植入支架30枚,3例支架内继发急性血栓形成,经过保留导管溶栓治疗成功溶解血栓,2例术后出现肺栓塞,经过血栓抽吸 抗凝溶栓治疗症状缓解,1例3个月后上腔静脉综合征复发,再次植入1枚支架后上腔静脉重新开通,其余病例在生存期内支架保持通畅。结论上腔静脉支架植入联合支气管动脉栓塞化疗治疗肺癌所致上腔静脉综合征,缓解症状迅速有效、微创、并发症较少,可以明显提高患者的生存质量。     

Leiomyosarcoma of the superior vena cava: diagnosis by endovascular biopsy

We report the case of a 69-year-old woman with leiomyosarcoma of the superior vena cava presenting with acute superior vena cava syndrome (SVCS). CT and MRI failed to fully characterize the endovascular process. Percutaneous endovascular biopsy, followed by metallic stent placement to treat the SVCS, confirmed the diagnosis. Symptoms resolved within 48 hours and surgical resection of the tumor was performed one month later. Unfortunately the patient died two weeks later because of intracranial hemorrhage.     

Stent-graft in the management of superior vena cava syndrome

We report the use of a Dacron-covered Gianturco-RöschZ (GRZ)-stent to treat malignant obstruction of the superior vena cava (SVC). Initial treatment with an uncovered GRZ-stent was suboptimal due to protrusion of tumor-thrombus through the stent struts into the SVC lumen. Placement of a coaxial Dacron-covered stent graft relieved the residual obstruction due to tumor within the SVC.     

Inferior vena cava filter from left-sided superior vena cava

We describe the unusual case of a 71-year-old male with a history of deep vein thrombosis and recurrent multiple pulmonary embolism (PE) despite adequate anticoagulation. Computed tomography (CT) and brachiocephalic venography revealed a left-sided superior vena cava. We describe successful placement of an inferior vena cava filter via a left-sided superior vena cava.     

Bridging stent placement through the superior vena cava to the inferior vena cava in a patient with malignant superior vena cava syndrome and an iodinated contrast material allergy

Positioning is critical during the placement of superior vena cava (SVC) stents in patients with malignant SVC syndrome. Although SVC stents effectively relieve various symptoms of SVC syndrome, improper stent positioning may cause life-threatening complications such as migration that result in fatal cardiac failure. Here we describe a patient with an allergy to iodinated contrast material (ICM) who presented with SVC syndrome owing to mediastinal lymph node metastases from hepatocellular carcinoma, which was successfully treated with an SVC stent. Secure stent placement was achieved by bridging the stent through the SVC to the inferior vena cava with venography using carbon dioxide instead of ICM.