Superior vena cava syndrome and infection of pacing leads in one patient

The superior vena cava (SVC) syndrome is an uncommon complication due to permanent transvenous pacemaker electrodes. Infection of the leads is a risk factor for its occurrence. After being treated for SVC syndrome, due to multiple pacemaker leads, with thrombolysis and coumarine therapy, our patient was diagnosed with repetitive positive blood cultures. Because of relapsing SVC syndrome all pacemaker material was surgically removed. Recovery was complete and the patient remained pacemaker-independent. Culture of the leads showed the same coagulase-negative staphylococci as in the blood cultures.The indications for pacemaker implantation should always be rigorously defined and complications thoroughly investigated and treated.     

Superior vena cava syndrome caused by Nocardia asteroides

A patient developed the superior vena cava syndrome from Nocardia asteroides pneumonia with mediastinitis. Specific treatment was dangerously delayed because malignancy was primarily suspected, and nocardial infection was not initially considered. The correct diagnosis was eventually made by appropriate stains and culture of a lung aspirate. Specific therapy with sulfonamide resulted in a cure of the infection, disappearance of facial swelling, and a long-term state of clinical well-being. Active nocardial pneumonia with mediastinitis is a treatable cause of the superior vena cava syndrome and should be considered in the differential diagnosis.     

Superior vena cava syndrome caused by pulmonary amoebic abscess

Isolated pulmonary amoebiasis without involvement of liver and other systems is extremely rare. Its presentation with superior vena cava (SVC) syndrome is not well documented. The case of 38-year-old male who developed SVC syndrome due to a large pulmonary amoebic abscess, which initially mimicked a pulmonary neoplasm with distal lung abscess is presented here. Subsequent bacteriological examination of the aspirated pus and the sputum along with suggestive serology confirmed the diagnosis of pulmonary amoebic abscess.     

Superior vena cava syndrome caused by bronchogenic cyst.

A patient with superior vena cava syndrome due to an infected benign mediastinal bronchogenic cyst is reported. Although bronchogenic cyst is a rare cause of the superior vena cava syndrome, it should be considered because it is a potentially treatable lesion. Patients with bronchogenic cysts should have elective surgery before major complication develop.     

Superior vena cava syndrome caused by invasive aspergillosis.

A 37-year-old man with blastic crisis of chronic myelogenous leukemia was admitted for chemotherapy. After treatment with an infusion of vincristine, he became leukopenic and febrile. Two episodes of gram-negative septicemia were treated with prolonged courses of antibiotics; however, fever persisted, and the patient developed the superior vena cava syndrome. Despite therapy with amphotericin B, the patient died. At autopsy a thrombus of Aspergillus was found completely occluding the superior vena cava.     

Superior vena cava syndrome induced by endocardial defibrillator and pacemaker leads

Two cases of superior vena cava syndrome induced by endocardial defibrillator and pacemaker leads are described. The 2 patients had histories of multiple endocardial leads and device upgrades and venous thrombosis. The first patient was treated with laser lead extraction followed by percutaneous venoplasty and stenting. The second patient was treated conservatively with long-term anticoagulation. The 2 patients had symptomatic reduction. In conclusion, superior vena cava syndrome induced by transvenous leads is an uncommon but serious complication. Anticoagulation can be effective in select patients, but in severe cases, thrombolytic therapy or surgical or percutaneous intervention may be required.     

Superior vena cava syndrome caused by a pseudoaneurysm of the ascending aorta

Pseudoaneurysm of the ascending aorta is a well known complication after aortic root surgery. A case of a large pseudoaneurysm is reported, seen as a superior vena cava syndrome, a very rare clinical presentation. Perioperative transoesophageal echocardiography showed the presence of a large pseudoaneurysm starting from the left coronary ostium implantation.     

Superior vena cava syndrome in children

Superior vena cava syndrome (SVCS) is rare in childhood. 18 cases of SVCS were seen in children ranging from 3–14 years with a mean age of 8.8 years. There were 15 males and 3 female children. Diagnosis could be confirmed in 17 cases as one child succumbed to severe respiratory distress without a definitive diagnosis. The commonest cause of SVCS was lymphoma. Non-Hodgkin’s lymphoma (NHL) was more common than Hodgkin’s disease. In two cases the final diagnosis was tuberculosis of mediastinal lymph nodes. The diagnosis was confirmed by cervical lymph node biopsy in 6 cases, mediastinal biopsy in 6 cases and bone marrow aspiration in the remaining 5 cases. Intravenous Dexamethasone provided relief of symptoms in 13 patients. None of the children received emergency radiotherapy. Anti-tubercular treatment produced complete cure in the two patients with tubercular mediastinal lymphadenopathy.     

Superior vena cava syndrome: diagnostic procedures

The hospital records of patients discharged from Presbyterian-University Hospital of Pittsburgh with the diagnosis of superior vena cava syndrome (SVCS) were reviewed in order to determine if diagnostic procedures were associated with an unacceptable risk of complications. Fifty-six cases were reviewed. Symptoms had been present for an average of five weeks. Forty-five patients underwent diagnostic tests including sputum cytology, lymph node biopsy, bone marrow biopsy, bronchoscopy, mediastinoscopy and thoracotomy. The diagnostic yield of these procedures ranged from 28% (cytology) to 100% (thoracotomy). Complications occurred only with mediastinoscopy and none of these were fatal or caused long-term morbidity. We conclude that most patients with SVCS (excepting those with neurologic or respiratory compromise) can tolerate a vigorous pursuit of a histologic diagnosis before therapy is instituted.     

Superior vena cava syndrome after bone marrow transplantation caused by aspergillosis: a case report

Aspergillosis is known for the variety of unusual presentations in immuno-suppressed patients. We report a patient in whom aspergillosis caused the superior vena cava (SVC) syndrome. A 37-year-old woman became febrile soon after bone marrow transplantation (BMT). Chest radiography demonstrated a 5-cm mass extending from the right lung apex to the right supraclavicular fossa beside her Hickman catheter. She then developed SVC syndrome, which progressed despite treatment. Despite recovery of the white blood cell count, the patient continued to deteriorate, became comatose, suffered a cardiac arrest and died 31 days after BMT. Autopsy revealed Aspergillus infection at the apex of the right lung associated with innominate artery thrombosis.     

Superior vena cava syndrome caused by systemic lupus erythematosus in a patient with longstanding rheumatoid arthritis

Superior vena cava syndrome is mostly related to a malignant process, but many different benign causes have also been described. We report a patient with longstanding classic rheumatoid arthritis (RA), who developed a superior vena cava syndrome due to mediastinal lymphadenopathy. At that time she also fulfilled the ARA criteria for systemic lupus erythematosus (SLE). Histological examination of a lymph node biopsy revealed necrosis, hematoxylin bodies and LE cells, while a great amount of amorphous proteinaceous material was seen positive with immunofluorescence for IgG, IgM and complement (C3 and Clq). A diagnosis of superior vena cava syndrome due to mediastinal lymphadenopathy in a patient with SLE which had evolved from longstanding RA was established.