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Bekele S, Kuhnly N, Chen LL. Essential Review of Oncological Emergencies. Crit Care Nurs Q 2024; 47:175-183. [PMID: 38860947 DOI: 10.1097/cnq.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Innovations in oncology have expanded treatment eligibility, leading to a rise in cancer patients requiring critical care. This necessitates that all critical care clinicians possess a fundamental knowledge of prevalent oncological conditions and identify emergent scenarios requiring immediate action. This article will explore key oncological complications and their management approaches.
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Affiliation(s)
- Sara Bekele
- Author Affiliations: Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York (Ms Bekele); Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Mr Kuhnly and Dr Chen)
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2
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Shewbridge A, Meade E, Dowling M. Treatment and Management of the Clinical Manifestations of Advanced Breast Cancer. Semin Oncol Nurs 2024; 40:151549. [PMID: 38155030 DOI: 10.1016/j.soncn.2023.151549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES People with advanced breast cancer (ABC) experience complex and debilitating physical symptoms of their disease that can have a profound effect on quality of life. This report provides an overview of the clinical manifestations related to different metastatic sites in ABC and potential oncologic emergencies. DATA SOURCES Date sources include peer-reviewed papers sourced in electronic databases (CINAHL, MEDLINE, Google Scholar) and national and international best practice guidelines. CONCLUSION People living with ABC experience multiple symptoms of disease that can impact on quality of life and physical functioning. The most common sites of metastatic disease are bone, lung, liver and brain. Clinical manifestations of ABC include pain, pathologic fractures, pleural effusions, and ascites. Potential oncologic emergencies related to these metastatic sites include hypercalcemia, malignant spinal cord compression, superior vena cava obstruction, and raised intracranial pressure. IMPLICATIONS FOR NURSING PRACTICE It is important for nurses to have informed knowledge and understanding of these clinical manifestations. This will enable them to be vigilant and perform targeted patient evaluation to assess signs and symptoms with a view to identifying potentially life-threatening emergencies and initiating interventions or appropriate referral or follow-up accordingly.
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Affiliation(s)
| | - Elizabeth Meade
- Registered Advanced Nurse Practitioner in Oncology, Midland Regional Hospital, Tullamore, Co Offaly, Ireland
| | - Maura Dowling
- Associate Professor, School of Nursing and Midwifery, University of Galway, Ireland
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3
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Celik NB, Wadiwala IJ, Sadek M, Ibrahim R, Alomari M, Alamouti-Fard E, Raavi L, Hussain MWA, Jacob S. Using Fenestrated Stent to Increase the Flow of Extracorporeal Membrane Oxygenation of Superior Vena Cava Compression Syndrome. Cureus 2023; 15:e46008. [PMID: 37766775 PMCID: PMC10521936 DOI: 10.7759/cureus.46008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 09/29/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is an obstruction of the venous return through the superior vena cava (SVC) or any other significant branches. The obstruction may be external, like thoracic mass compressing the SVC, or internal, like thrombosis or tumor, which directly invades the SVC. Patients experiencing a medical emergency after being initially stabilized require treatment for SVCS, including endovenous recanalization and the implantation of an SVC stent to reduce the risk of abrupt respiratory arrest and death. A 54-year-old female presented from the university medical center with weight loss and solid food dysphagia for three months. Chest-CT scan showed a mediastinal mass of 10 x 9 x 8 cm. A transbronchial biopsy was attempted. The patient was arrested during the bronchoscopy lab procedure. Cardiopulmonary resuscitation (CPR) was initiated, and venoarterial-extracorporeal membrane oxygenation (VA-ECMO) was done through the right femoral artery cannula size 15 Fr due to the narrowing of the artery and the left femoral vein cannula size 23 Fr. During the night shift, the ECMO flow was hard to maintain with fluids, which was realized with the ECMO outflow volume issue. The next day, in the hybrid operating room, a fenestrated SVC stent was placed in the SVC, brachiocephalic, and internal jugular veins. The patient's hemodynamics improved post-stenting, especially ECMO outflow. This case illustrates that stenting in SVCS is a valid therapeutic option to increase the ECMO flow in this patient group.
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Affiliation(s)
| | - Ishaq J Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | - Mustafa Sadek
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | - Ramez Ibrahim
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | | | - Lekhya Raavi
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | | | - Samuel Jacob
- Department of Cardiothoracic Surgery, Heart and Lung Transplant National Recovery Program, Jacksonville, USA
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4
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Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A, Bellou A, Esposito C, Ceresa IF, Savioli G. Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments. Curr Oncol 2023; 30:7315-7334. [PMID: 37623012 PMCID: PMC10453099 DOI: 10.3390/curroncol30080531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.
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Affiliation(s)
- Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Valentina Monticone
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Damiano Fuschi
- Department of Italian and Supranational Public Law, School of Law, University of Milan, 20122 Milan, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | | | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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5
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Shah RP, Bolaji O, Duhan S, Ariaga AC, Keisham B, Paul T, Aljaroudi W, Alraies MC. Superior Vena Cava Syndrome: An Umbrella Review. Cureus 2023; 15:e42227. [PMID: 37605686 PMCID: PMC10439982 DOI: 10.7759/cureus.42227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is a medical emergency that encompasses an array of signs and symptoms due to obstruction of blood flow through the superior vena cava (SVC). It poses a significant healthcare burden due to its associated morbidity and mortality. Its impact on the healthcare system continues to grow due to the increasing incidence of the condition. This incidence trend has been attributed to the growing use of catheters, pacemakers, and defibrillators, although it is a rare complication of these devices. The most common cause of SVCS remains malignancies accounting for up to 60% of the cases. Understanding the pathophysiology of SVCS requires understanding the anatomy, the SVC drains blood from the right and left brachiocephalic veins, which drain the head and the upper extremities accounting for about one-third of the venous blood to the heart. The most common presenting symptoms of SVCS are swelling of the face and hand, chest pain, respiratory symptoms (dyspnea, stridor, cough, hoarseness, and dysphagia), and neurologic manifestations (headaches, confusion, or visual/auditory disturbances). Symptoms generally worsen in a supine position. Diagnosis typically requires imaging, and SVCS can be graded based on classification schemas depending on the severity of symptoms and the location, understanding, and degree of obstruction. Over the past decades, the management modalities of SVCS have evolved to meet the increasing burden of the condition. Here, we present an umbrella review providing an overall assessment of the available information on SVCS, including the various management options, their indications, and a comparison of the advantages and disadvantages of these modalities.
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Affiliation(s)
- Rajendra P Shah
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Olayiwola Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Center, Largo, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Anderson C Ariaga
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Bijeta Keisham
- Sinai Center for Thrombosis and Research, Sinai Hospital of Baltimore, Baltimore, USA
| | - Timir Paul
- Section of Interventional Cardiology, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, USA
| | - Wael Aljaroudi
- Department of Cardiology, Augusta University Medical College of Georgia, Augusta, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, USA
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6
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Yao J, Novosel M, Bellampalli S, Kapo J, Joseph J, Prsic E. Lung Cancer Supportive Care and Symptom Management. Hematol Oncol Clin North Am 2023; 37:609-622. [PMID: 37024385 DOI: 10.1016/j.hoc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.
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Affiliation(s)
- Johnathan Yao
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Madison Novosel
- Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Shreya Bellampalli
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jennifer Kapo
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA
| | - Julia Joseph
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Elizabeth Prsic
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT 06520, USA.
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7
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Lee KY, Shueng PW, Hsu CX. Radiation therapy for oncologic emergencies: The burden or needs for hospitalizations in patients with lung cancer. Am J Emerg Med 2023; 66:170. [PMID: 36681596 DOI: 10.1016/j.ajem.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kuan-Yu Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Xiong Hsu
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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8
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Issani A. An updated narrative review on the management of the most common oncological and hematological emergencies. Dis Mon 2023; 69:101355. [PMID: 35379468 DOI: 10.1016/j.disamonth.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.
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Affiliation(s)
- Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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9
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Muacevic A, Adler JR, Scott C, Duff R. Endobronchial Ultrasound Diagnosis of a Malignant Superior Vena Cava Tumor Thrombus Extending Into the Right Atrium: An Unusual Cause of Recurrent Syncope. Cureus 2022; 14:e31704. [PMID: 36561585 PMCID: PMC9767682 DOI: 10.7759/cureus.31704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
The superior vena cava (SVC) is mainly responsible for the return of blood flow from the head, upper limbs, and neck into the right atrium. The large vein can be subject to extrinsic tumor compression and invasive intraluminal tumors-metastatic and mediastinal tumors that can lead to complete or partial occlusion. SVC occlusion can also result from chronic inflammation or scarring of the vessel iatrogenically by pacemaker wires or venous access ports used for chemotherapy, long-term antibiotics, or hemodialysis. Patients with SVC occlusion present with a constellation of clinical abnormalities that make up SVC syndrome. SVC syndrome includes varying degrees of facial fullness, neck and upper extremity swelling, dyspnea, and classically dilated collateral veins in the upper chest. Very rarely do patients present with syncope, hoarseness, dysphagia, or acute encephalopathy. The diagnosis of SVC syndrome is best established on imaging such as CT Chest with contrast; however, on rare occasions, it can be discovered by endobronchial ultrasound. We present an unusual presentation of SVC syndrome- primarily presenting as frequent syncopal episodes- diagnosed via endobronchial ultrasound.
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10
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Gould Rothberg BE, Quest TE, Yeung SCJ, Pelosof LC, Gerber DE, Seltzer JA, Bischof JJ, Thomas CR, Akhter N, Mamtani M, Stutman RE, Baugh CW, Anantharaman V, Pettit NR, Klotz AD, Gibbs MA, Kyriacou DN. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin 2022; 72:570-593. [PMID: 35653456 DOI: 10.3322/caac.21727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high-acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up-to-date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy-induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug-conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T-cells, are summarized. Finally, strategies for facilitating same-day direct admission to hospice from the ED are discussed. This article not only can serve as a point-of-care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.
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Affiliation(s)
- Bonnie E Gould Rothberg
- Yale Cancer Center Innovations Laboratory, Yale Comprehensive Cancer Center, New Haven, Connecticut
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lorraine C Pelosof
- Office of Oncologic Diseases, US Food and Drug Administration, Silver Spring, Maryland
| | - David E Gerber
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas
| | - Justin A Seltzer
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mira Mamtani
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robin E Stutman
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, SingHealth Duke-National University of Singapore Academic Medical Center, Singapore, Singapore
| | - Nicholas R Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D Klotz
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Gibbs
- Department of Emergency Medicine, Atrium Health-Carolinas Medical Center, Charlotte, North Carolina
| | - Demetrios N Kyriacou
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Chandrakumanan A, Tee SW, Sylverster M, Richards A, Chew LG. A rare case of azygous vein aneurysm with cotriatrium dextrum. J Surg Case Rep 2022; 2022:rjac413. [PMID: 36131808 PMCID: PMC9486592 DOI: 10.1093/jscr/rjac413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Azygous vein aneurysm (AVA) is an infrequent entity for posterior mediastinal lesion and paratracheal mass. Usually asymptomatic, AVA is discovered during routine examination of a patient. The patho-etiology of the azygous vein aneurysm has not been fully understood till date, making it difficult to postulate the most common cause for its occurrence. Nonetheless, AVA has to be taken into consideration as a differential diagnosis for posterior mediastinal mass or right paratracheal lesion. The objective of this paper is to report a rare case of AVA and further discuss on its patho-etiology leading to the dilatation of azygous vein aneurysm.
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Affiliation(s)
| | - Sui Wu Tee
- Department of General and Vascular Surgery, Serdang Hospital , Selangor , Malaysia
| | - Melvin Sylverster
- Department of General and Vascular Surgery, Serdang Hospital , Selangor , Malaysia
| | - Avisha Richards
- Department of General and Vascular Surgery, Serdang Hospital , Selangor , Malaysia
| | - Loon Guan Chew
- Department of General and Vascular Surgery, Serdang Hospital , Selangor , Malaysia
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12
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Patriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I, Charpidou A, Trontzas I, Syrigos N, Kotteas E, Dimakakos E. Malignant Superior Vena Cava Syndrome: State of the Art. Cureus 2022; 14:e20924. [PMID: 35004083 PMCID: PMC8727327 DOI: 10.7759/cureus.20924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.
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13
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Clinical analysis of 48 cases of malignant superior vena cava syndrome. World J Surg Oncol 2021; 19:185. [PMID: 34162380 PMCID: PMC8223363 DOI: 10.1186/s12957-021-02300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of our study was to observe and compare the curative effect of radiotherapy, chemotherapy, and combined radiotherapy and chemotherapy, as well as comprehensive treatment on superior vena cava syndrome (SVCS) caused by malignant etiology. Methods A total of 48 patients with malignant SVCS admitted to our hospital from 2015 to 2020 were selected in this study. According to the different treatment methods, they were divided into radiotherapy group (group 1, 10 cases), chemotherapy group (group 2, 8 cases), combined radiotherapy and chemotherapy group (group 3, 22 cases), and comprehensive treatment group (group 4, 8 cases). Results There were no significant differences in efficacy and side effects among the four groups (all P > 0.05). Group 4 (median survival time of 36 months) could provide longer survival time than groups 1, 2, and 3 (median survival time of 10 months, 13.5 months, and 12 months, respectively). Conclusions For patients with severe symptoms or good prognosis, comprehensive treatment could be selected to improve the quality of life and prolong the survival period; for patients with mild symptoms, radiotherapy, chemotherapy, or combined radiotherapy and chemotherapy could also reduce the symptoms of SVCS and treat tumor lesions.
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14
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Iatrogenic superior vena cava syndrome with concomitant deep vein thrombosis of azygos and hemiazygos veins. Radiol Case Rep 2021; 16:1895-1898. [PMID: 34113414 PMCID: PMC8170043 DOI: 10.1016/j.radcr.2021.04.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
Iatrogenic superior vena cava syndrome (SVCs) represents an emergent diagnostic entity and its correlation with deep vein thrombosis is extremely rare. Recently, the increased use of indwelling lines, pacemakers and intracardiac devices has led to more cases of SVC syndrome also associated with a higher frequency of DVT. We report an unusual complication in a 74-year-old female, who has been undergoing hemodialysis via CVC for 14 years, who referred at our Emergency Department complaining of shortness of breath, headache, face and neck swelling. She underwent chest Computed Tomography Angiography (CTA), that showed a thrombus extending from the superior vena cava to the azygos and hemiazygos veins. Acute SVCs should be suspected in emergency settings in symptomatic patients with indwelling central lines, catheters and pacemakers. CTA represents an accurate and quick imaging modality for the diagnosis and the assessment of the extension of the thrombus.
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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16
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Molina-Gil J, Calleja-Puerta S, Rico M. Infarto cerebral por embolismo paradójico secundario a síndrome de vena cava superior por malposición de un catéter de derivación ventriculoauricular. Neurologia 2021; 36:325-327. [DOI: 10.1016/j.nrl.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/25/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022] Open
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17
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Molina-Gil J, Calleja-Puerta S, Rico M. Ischaemic stroke secondary to paradoxical embolism as a consequence of superior vena cava syndrome by a displacement of a ventriculoatrial shunt. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Alwusaibie SA, Alsayigh JS, Alfaraj D, Alomair AM, Alsaeed SA. Intermittent Superior Vena Cava Syndrome Secondary to Malignant Pericardial Mesothelioma. Cureus 2020; 12:e12107. [PMID: 33489524 PMCID: PMC7805494 DOI: 10.7759/cureus.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/05/2022] Open
Abstract
Malignant pericardial sarcomatoid mesothelioma is a massively rare tumor accounting for 0.8% of all cases of mesothelioma. Superior vena cava syndrome (SVCS) occurs due to a partial obstruction or compression to the superior vena cava, which hinders the blood outflow to the upper body. It can be caused by an intrinsic factor such as thrombosis, or by an extrinsic factor such as tumors. Clinical presentation includes edema of the face and upper limbs, plethora, dyspnea, dysphagia, stridor and cough. we are reporting a case of a 56-year-old female, who is a known case of hypertension on angiotensin-converting enzyme inhibitors (ACEIs). Presented to the emergency department with intermittent facial swelling and dyspnea. Imaging and pathology reports confirmed the diagnosis of intermittent SVCS secondary to pericardial sarcomatoid mesothelioma with pericardial effusion. What makes our case unique is that both the etiology and the presenting complaint are rare entities, as most SVCS cases are continuously symptomatic throughout the disease course, and are usually caused by a lung cancer or lymphoma.
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Affiliation(s)
| | - Jaffar S Alsayigh
- Emergency Department, King Fahad University Hospital, Al Khobar, SAU
| | - Dunya Alfaraj
- Emergency Department, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Al Khobar, SAU
| | | | - Sarah A Alsaeed
- Cardiology/Echocardiography, King Fahad University Hospital, Al Khobar, SAU
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19
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Nieves Condoy JF, Zúñiga Vázquez LA, Páez Hernández EM, Jiménez Herevia AE, Acuña Pinzon CL. Superior Vena Cava Syndrome Due to Thymic Carcinoma. Cureus 2020; 12:e11670. [PMID: 33391908 PMCID: PMC7769725 DOI: 10.7759/cureus.11670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The superior vena cava syndrome (SVCS) is caused by a mechanical obstruction; 90% are of neoplasic etiology (lung cancer (LC) and non-Hodgkin lymphoma (NHL) mostly), epithelial neoplasms of the thymus (NET) is a rare cause, thymic carcinoma (TC) causing less than 1% of cases. A 56-year-old male presented with a four-month history of dyspnea, dysphonia, facial and cervical edema and bilateral cervical lymphadenopathy. The tomography showed bilateral, mediastinal, retroperitoneal lymphadenopathies, and obstruction of the internal jugular vein, right apical pulmonary nodules. A superficial adenopathy biopsy was taken, which is not conclusive, so it was decided to take an image-guided biopsy. During its evolution, it presents asymptomatic cardiovascular changes; in extension studies, systemic disease is evidenced. The definitive histopathological study reported thymic carcinoma. Systemic treatment with chemotherapy and radiation therapy was planned.
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20
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Anand V, Maybody M, Fischer GW, Dabo-Trubelja A. Acute Hemodynamic Compromise following Superior Vena Cava Stent Placement: A Case Report. ACTA ACUST UNITED AC 2020; 2:2953-2956. [PMID: 33458570 DOI: 10.1007/s42399-020-00629-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Symptomatic relief of Superior Vena Cava (SVC) syndrome caused by tumor obstruction is achieved by the placement of a percutaneous superior vena cava stent. Complications are rare. Even more uncommon is acute hemodynamic compromise from acute hemopericardium during placement of an SVC stent. Point of Care Ultrasound (POCUS) in the Interventional Radiology Suite (IR) suite allows for rapid diagnosis and guidance of pericardial drainage and hemodynamic management.
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Affiliation(s)
- Vaibhav Anand
- Dept of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Majid Maybody
- Interventional Radiology Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Gregory W Fischer
- Dept of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Anahita Dabo-Trubelja
- Perioperative Echocardiography and Ultrasound; Director, Onco-Anesthesia Anesthesia Fellowship, Memorial Sloan Kettering Cancer Center, New York, NY 10065, 1275 York Ave., C-330
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21
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Hillner B, Rehmenklau-Bremer L, Wrase C, Fuchs H, Herold T, Beyer L. Superior vena cava syndrome. VASA 2020; 49:437-448. [PMID: 33103626 DOI: 10.1024/0301-1526/a000908] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The superior vena cava syndrome (SVCS) is caused by compression, invasion, and/or thrombosis of the superior vena cava and/or the brachiocephalic veins. Benign SVCS is separated from malignant SVCS. SVCS comprises a broad clinical spectrum reaching from asymptomatic cases to rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. Symptoms are correlated to the acuity and extent of the venous obstruction and inversely correlated to the development of the venous collateral circuits. Imaging is necessary to determine the exact underlying cause and to guide further interventions. Interventional therapy has widely changed the therapeutic approach in symptomatic patients. This article provides an overview over this complex syndrome and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Saban Elitok
- Clinic for Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Andreas Ruttloff
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Sabine Reinhold
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Jessika Nielitz
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Julia Steindl
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | | | | | - Christian Wrase
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Heiko Fuchs
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Thomas Herold
- Radiology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
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22
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Li N, Zeng N, Chen B, Huang Y. Endovascular treatments of tunneled central venous catheter-induced superior vena cava complete occlusion via through-and-through technique. Hemodial Int 2020; 25:35-42. [PMID: 33040490 DOI: 10.1111/hdi.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Superior vena cava occlusion (SVCO) induced by tunneled central venous catheter (tCVC) is an uncommon but challenging complication of hemodialysis patients. The aim of this study was to access the efficacy, safety, and patency of stents in tCVC-related SVCO via through-and-through technique. METHOD We retrospectively identified seven patients with benign SVCO secondary to tCVC treated with endovascular approaches successfully between 1 March 2013 and 31 October 2019. Patients' demographic data, clinical signs and symptoms, and imaging data were followed up and recorded. RESULTS Technical success was achieved in all cases. All the patients were performed with percutaneous transcatheter angioplasty (PTA) and subsequently stent placement via the through-and-through technique. During follow-up, four patients underwent secondary interventions, including PTA and/or stent placement. The primary patency after 3, 6, 9 and 12 months was 100%, 100%, 86% and 86%, and secondary patency after 12 months was 100%. No procedure-related deaths occurred. CONCLUSIONS Endovascular management of SVCO is a safe and effective approach. CT examination can provide a direction for endovascular treatment and periodic surveillance.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ni Zeng
- Research Center of Medical Sciences, Guangdong General Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bin Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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23
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Kehoe K, Prasad M, Vats A. Refractory cerebrospinal fluid leak following posterior fossa surgery secondary to superior vena cava obstruction: a case report. Br J Neurosurg 2020; 36:651-653. [PMID: 33012184 DOI: 10.1080/02688697.2020.1828276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a case of refractory post-operative cerebrospinal fluid leak from a posterior fossa operative site secondary to superior vena cava construction. The patient developed the leak after a posterior fossa craniotomy and resection of a cerebellar lung metastasis. The leak persisted despite conservative measures and lumbar drain insertion. Suspicion of superior vena cava obstruction was raised following clinical examination. She was managed with stenting of the superior vena cava, with cessation of leak.
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Affiliation(s)
- Kristy Kehoe
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Atul Vats
- James Cook University Hospital, Middlesbrough, UK
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24
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Vena cava superior syndrome in the children with mediastinal tumors: Single-center experience. North Clin Istanb 2020; 7:255-259. [PMID: 32478297 PMCID: PMC7251265 DOI: 10.14744/nci.2019.46354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: Vena cava superior syndrome comprises various symptoms of compression of vena cava superior. The results of increased venous pressure in the upper body may cause edema of the head and neck associated with cyanosis, plethora and distended subcutaneous vessels. Vena cava superior syndrome is rare in childhood. Therefore, we planned this retrospective study. METHODS: The retrospective study was carried out on the children with mediastinal tumors in the Department of Pediatric Hematology-oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey , from January 2010 to December 2017. Diagnostic procedures included hematological investigations, chestradiography, thoracic computed tomography, echocardiography and lymph node or mediastinal biopsy. RESULTS: In this study, 19 (five were female) of 41 patients with mediastinal tumors had Vena cava superior syndrome. Diagnosis included Hodgkin’s lymphoma in seven (37%), non-Hodgkin’s lymphoma in six (32%), acute T- lymphoblastic leukemia in four (21%), neuroblastoma and anaplastic round cell sarcoma in one each respectively. All of the 19 patients’ facial swelling, venous distention and mediastinal widening. All patients received intravenous corticosteroids (0.6 mg/kg dexamethasone). Furthermore, the patient with anaplastic round cell sarcoma received emergency radiotherapy. No patients died because of Vena cava superior syndrome. CONCLUSION: Vena cava superior syndrome is a medical emergency that requiresurgent treatment. Vena cava superior syndrome studies in children are rare. In this retrospective study, we found that the most common cause of Vena cava superior syndrome was Hodgkin’s lymphoma different from literature.
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25
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Thukral S, Vedantham S. Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome. J Clin Med 2020; 9:E1439. [PMID: 32408611 PMCID: PMC7290684 DOI: 10.3390/jcm9051439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023] Open
Abstract
Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.
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Affiliation(s)
- Siddhant Thukral
- School of Medicine, University of Missouri—Kansas City, Kansas City, MO 64108, USA;
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
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26
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Entezami P, Custozzo A, Adamo M. Macrocephaly Secondary to Superior Vena Cava Syndrome. Pediatr Neurosurg 2020; 55:42-45. [PMID: 32069465 DOI: 10.1159/000503111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
Cardiac defects in neonates are often associated with neurological or neuroanatomical anomalies. We present a patient who developed macrocephaly secondary to superior vena cava syndrome, resultant from repair of her congenital tetralogy of Fallot. She was managed conservatively with serial imaging and close observation from the neurosurgical aspect, and her head growth stabilized without requiring ventriculoperitoneal shunting after stent placement in her superior vena cava. In patients with macrocephaly secondary to cardiac issues, cerebrospinal fluid diversion is often performed quickly. For our patient - who had no obvious signs of worsening intracranial hypertension or symptoms beyond macrocephaly - treatment of her overall cardiovascular issues was successful in achieving stability of her head circumference growth.
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Affiliation(s)
- Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Amanda Custozzo
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Matthew Adamo
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA,
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27
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Benignus C, Burger L, Haap M, Horger M, Riessen R. [Large mediastinal mass with protrusion into the right atrium]. Med Klin Intensivmed Notfmed 2019; 115:156-158. [PMID: 31811309 DOI: 10.1007/s00063-019-00644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- C Benignus
- Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - L Burger
- Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - M Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, 72076, Tübingen, Deutschland
| | - M Horger
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - R Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, 72076, Tübingen, Deutschland.
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28
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Venous Collateral Pathways in Superior Thoracic Inlet Obstruction: A Systematic Analysis of Anatomy, Embryology, and Resulting Patterns. AJR Am J Roentgenol 2019; 213:200-210. [DOI: 10.2214/ajr.18.20172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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