Superior vena cava syndrome with retropharyngeal edema as a complication of ventriculoatrial shunt

Thirty‐seven‐year old female with hydrocephalus managed by a ventriculoatrial (VA) shunt presented with upper body edema, dysphagia, and headache. Imaging demonstrated thrombosis of the superior vena cava (SVC). Direct catheter thrombolysis led to resolution of thrombus burden. Superior vena cava thrombosis is a rare consequence of VA shunting and must be managed emergently.     

Superior vena cava syndrome: An oncologic complication

Superior vena cava syndrome (SVCS) is an oncologic complication resulting from the partial or complete obstruction of the superior vena cava by tumor invasion, extrinsic compression, or thrombosis. The appearance of symptoms may be gradual or insidious. Acute onset of symptoms may result in a relative oncologic emergency. Controversy exists as to the absolute necessity of establishing a histiologic diagnosis prior to the initiation of treatment. Radiation therapy remains the primary means of treatment except for small cell lung cancer and lymphoma where chemotherapy is considered the treatment of choice. Nursing management is directed toward assessment and identification of high-risk patients, astute observation and provision of supportive care for the patient with acute SVCS, and prevention of further side effects of therapy.     

Suppurative thrombosis of the superior vena cava: a lethal complication of central venous catheters

A case is described, in which suppurative thrombosis of the superior vena cava, complicated central venous catheterization. Persistent septicaemia resulted which was unresponsive to medical management and was ultimately fatal.     

Hydatid cyst of the liver presenting as an inferior vena cava obstruction

A 48-year-old woman presented with clinical features suggestive of an obstruction of the inferior vena cava (IVC). Abdominal sonography showed a 15- x 14-cm cystic mass involving the medial segment of the left hepatic lobe and the anterior segment of the right hepatic lobe. We visualized multiple intracystic floating membranes, a detached endocyst, and a daughter cyst within the main cyst. The cyst was compressing and effacing the intrahepatic portion of the IVC and the right atrium. Sonography of the right and left hepatic veins showed blood flow in the normal direction, but spectral analysis showed that the flow was continuous, possibly owing to extrinsic compression of the IVC at the site where the hepatic veins drained into the IVC. The patient responded well to percutaneous treatment of the hydatid cyst. This case represents a rare presentation of a hydatid cyst of the liver.     

Superior vena cava syndrome

OBJECTIVES: To provide a review of the treatment and nursing management of superior vena cava syndrome (SVCS). DATA SOURCES: Review articles, research studies, and book chapters. CONCLUSIONS: SVCS is primarily associated with small cell lung cancer. It usually has a chronic, insidious onset, but may present acutely with laryngeal or cerebral edema. Radiotherapy, chemotherapy, surgery, thrombolysis, and interventional radiology have provided effective treatment. IMPLICATIONS FOR NURSING PRACTICE: Management of the patient with SVCS includes recognition of high-risk patients and initial symptomatology, accurate assessments, appropriate therapies, psychosocial support, and education regarding recurrent SVCS.     

A primary cardiac sarcoma presenting with superior vena cava obstruction

Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are non–small cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic. The diagnosis of SVC obstruction secondary to a primary cardiac sarcoma was established based on clinical, radiologic, and post-mortem findings. This is one of very few reported cases of a primary cardiac sarcoma causing SVC obstruction.     

Superior vena cava obstruction and mediastinal mass detected by point-of-care ultrasonography

Superior vena cava syndrome (SVCS) often relates to malignant causes such as lung tumors, metastatic cancer, or lymphomas. While the diagnosis relies nowadays on the use of contrast-enhanced thoracic computed tomography, ultrasonography may have an important value as a first-line imaging technique, particularly when used in point-of-care office-based settings. Here, we report the case of a 67-year-old male presenting with SVCS in whom ultrasound contributed to diagnosis.     

Inferior vena cava thrombosis presenting as lumbar radiculopathy

Lumbar epidural varices either primary or secondary to outflow obstruction have been implicated in causing lumbar radiculopathy. We report a case of an adolescent male who presented with lumbar radiculopathy attributable to thrombosed lumbar epidural varix as a result of inferior vena cava thrombosis emanating from factor V Leiden mutation. This rare cause of radiculopathy was diagnosed on contrast-enhanced computerized tomography. All symptoms resolved shortly after initiation of intravenous heparin therapy. The relevant literature is reviewed.     

Long-term central venous catheterization via persistent left superior vena cava

We report a case of a cancer patient who displayed a persistent left superior vena cava (PLSVC) after implantation of a central venous catheter (Port-a-Cath), as revealed by angiography. This anomaly is rather rare (0.3% of healthy individuals), and the few studies on the long-term maintenance of an implant in situ are not very informative. Nevertheless, based on the acceptable venous caliber and the patient's serious clinical situation, we decided to leave the catheter in place and perform infusional chemotherapy and supportive therapy with careful and continuous control. The patient died after 8 months of this therapy. No complications attributable to the catheter were observed. We think that the risk is acceptable in similar conditions.     

Leiomyosarcoma of the inferior vena cava presenting as a cardiac mass

Primary tumors of the inferior vena cava (IVC) are rare. The most common primary malignancy is leiomyosarcoma (LMS), with a severe prognosis. Right‐atrium (RA) involvement is seen in about 20 percent of cases. We report the case of a 53‐year‐old woman admitted to the intensive care unit because of progressive dyspnea with lower limb edema. Echocardiography demonstrated a large mass in the RA. At open‐heart surgery, the tumor appeared located in the IVC infrahepatic segment, completely obstructing the lumen and extending into the suprahepatic portion and the RA. Histopathological examination concluded to LMS.     

Tunnelled central venous catheter-induced thrombosis: a rare case of superior vena cava syndrome

Thrombotic venous obstruction in patients with a tunnelled central venous catheter is a cause of superior vena cava syndrome that is not routinely encountered by emergency physicians. Diagnosis requires identifying patients at risk (e.g., those under treatment for cancer and those who have a tunnelled central venous catheter), recognizing the signs and symptoms of superior vena cava syndrome, usually dyspnea and dilated neck or thoracic veins, and imaging the venous obstruction using computer tomography or sonography. Management involves anticoagulation and local thrombolytic administration. We report the case of a 28-year-old woman who presented with a 2-day history of face, chest and bilateral arm swelling who had been receiving maintenance chemotherapy for acute lymphoblastic leukemia through a Hickman catheter. This case demonstrates the need to be vigilant for thrombus formation in patients with long-term, indwelling central venous catheters.