Superior vena cava syndrome management in limited source setting: a case report
Keywords:Superior vena cava syndrome, Malignancy, Management
Superior vena cava syndrome (SVCS) is syndrome caused by mass compression, tumor invasion, and/or thrombosis of SVC. In the past, SVCS was mostly linked to infection. Nowadays, SVCS is mostly linked to malignant tumor and medical procedures. Most common malignant cause of SVCS is non small cell lung cancer. A 69-year-old man was presented with breathing difficulty. Symptom began 4 months before admission, with worsening of symptom since 2 weeks before admission. Symptom improved with sitting position, and worsened with supine position. Patient had been sleeping with 2 pillows. Patient had productive cough and hoarseness. Swelling of face and neck were present. Collateral vein distention was visible in the area of head, neck, and chest. Physical examination of lung revealed decreased vesicular breath sound at right side. Non pitting edema was found at both sides of upper extremity. SVCS in this case can be categorized into grade 2, chronic SVCS case. CT showed center right lung mass, although malignant cells were not obtained from pleural puncture and CT guided needle biopsy. Staging of mass was T4N3M1a. Mass finding at the center of right lung is in accordance with the previous findings that SVCS generally arise from lung (not mediastinum), and that right sided masses are generally more likely to cause SVCS. Management in this case was done by giving corticosteroid and diuretic. Surgery, radiotherapy, and immunotherapy were not done since malignancy diagnosis hadn’t been able to be concluded.
Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, et al. Superior vena cava syndrome. Vasa. 2020. Available at: https://econtent.hogrefe.com/doi/10.1024/0301-1526/a000908. Accessed on 22 September 2022.
Straka C, Ying J, Kong FM, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. Springer Plus. 2016;5:229.
Herscovici R, Szyper-Kravitz M, Altman A, Eshet Y, Nevo M, Agmon-Levin N, et al. Superior vena cava syndrome - changing etiology in the third millennium. Lupus. 2012;21(1):93-6.
Friedman T, Quencer K, Kishore S, Winokur R, Madoff D. Malignant venous obstruction: Superior Vena Cava syndrome and beyond. Semin Intervent Radiol. 2017;34(04):398-408.
Skovira V, Ahmed M, Genese TO. Superior Vena Cava Syndrome in Conjunction with Pulmonary Vasculature Compromise: A Case Study and Literature Review. Am J Case Rep. 2018;19:1237-40.
Yu JB, Wilson LD, Detterbeck FC. Superior vena cava syndrome--a proposed classification system and algorithm for management. J Thorac Oncol. 2008;3(8):811-4.
Lacout A, Marcy PY, Thariat J, Lacombe P, El Hajjam M. Radio-anatomy of the superior vena cava syndrome and therapeutic orientations. Diagn Interv Imaging. 2012;93(7-8):569-77.
Chang CY, Lai YC, Chang SC. Superior vena cava syndrome related fluid collection in retropharyngeal space. QJM. 2012;105(9):907-9.
Ghorbani H, Vakili Sadeghi M, Hejazian T, Sharbatdaran M. Superior vena cava syndrome as a paraneoplastic manifestation of soft tissue sarcoma. Hematol Transfus Cell Ther. 2018;40(1):75-8.
Azizi AH, Shafi I, Shah N, Rosenfield K, Schainfeld R, Sista A, Bashir R. Superior Vena Cava Syndrome. JACC Cardiovasc Interv. 2020;13(24):2896-910.
Besteiro B, Teixeira C, Gullo I, Pereira S, Almeida M, Almeida J. Superior vena cava syndrome caused by mediastinal lymphoma: A rare clinical case. Radiol Case Rep. 2021;16(4):929-33.
Ozcan A, Unal E, Karakukcu M, Coskun A, Ozdemir MA, Patiroglu T. Vena cava superior syndrome in the children with mediastinal tumors: Single-center experience. North Clin Istanb. 2020;7(3):255-9.
D’Cruz LG, Younes Bassam, Lai FA, Husain SA. Favourable prognosis when lung-cancer patients with superior vena cava obstruction (SVCO) are referred promptly to EBUS-TBNA prior to medical or surgical management. Jacobs J Pulmonol. 2015;1(3):012.
Lepper PM, Ott SR, Hoppe H, Schumann C, Stammberger U, Bugalho A, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care. 2011;56(5):653-66.
Tandberg DJ, Tong BC, Ackerson BG, Kelsey CR. Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: A comprehensive review. Cancer. 2018;124(4):667-78.
Ulas EB, Dickhoff C, Schneiders FL, Senan S, Bahce I. Neoadjuvant immune checkpoint inhibitors in resectable non-small-cell lung cancer: a systematic review. ESMO Open. 2021;6(5):100244.
Vinod SK, Hau E. Radiotherapy treatment for lung cancer: Current status and future directions. Respirology. 2020;25(2):61-71.