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Trivedi SB, Ray C, Chadalavada S, Makramalla A, Kord A. Superior Vena Cava Syndrome: An Update and Literature Review of Percutaneous Endovascular Treatments. Semin Intervent Radiol 2022; 39:446-453. [PMID: 36406024 PMCID: PMC9671675 DOI: 10.1055/s-0042-1757344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Surbhi B. Trivedi
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Charles Ray
- Division of Interventional Radiology, Department of Radiology, the University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Seetharam Chadalavada
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Abouelmagd Makramalla
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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Irace L, Martinelli O, Gattuso R, Mingoli A, Fiori E, Alunno A, Di Girolamo A, Crocetti D, Sapienza P. The role of self-expanding vascular stent in superior vena cava syndrome for advanced tumours. Ann R Coll Surg Engl 2021; 103:296-301. [PMID: 33682470 DOI: 10.1308/rcsann.2020.7127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Superior vena cava (SVC) syndrome (SVCS) is a life-threatening occurrence that necessitates prompt treatment. At present, endovascular stenting is proposed as a first-line treatment to relieve symptoms. We assessed the effectiveness, safety and outcome of SVC stent positioning in patients affected with advanced cancer. METHODS Forty-two patients undergoing stent positioning in the SVC for neoplasms from January 2002 to December 2018 form the basis of this retrospective study. Demographic data, risk factors, associated diseases, symptoms at presentation according to the score proposed by Kishi and the type of SVCS according to Sanford and Doty were collected. Minor and major complications were recorded. Suspected stent occlusion was confirmed by means of recurrence of symptoms followed by a confirmatory computed tomography (CT). RESULTS Thirty-four (81%) patients had a nonresectable lung tumour invading or compressing the SVC. Five (12%) patients had a non-Hodgkin's lymphoma, and three (7%) had metastatic lymphadenopathies. Nitinol stents (Memotherm®) were employed in 19 (45%) patients, and steel stents (Wallstent™) in the remaining 23 (55%) patients. Thirty-five (85%) patients died during follow up for disease progression and the overall survival rate at 24 months was 11% (standard error (SE)=0.058). Thirteen patients (32%) had a recurrence of SVCS because of stent thrombosis in three (23%) and extrinsic compression from uncontrolled cancer progression in ten (77%). The overall symptom-free interval at 24 months was 57% (SE=0.095). CONCLUSIONS We recommend the use of the endovascular procedure as a first-line treatment in locally advanced or metastatic tumour in the presence of SVCS.
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Affiliation(s)
- L Irace
- Sapienza University of Rome, Italy
| | | | | | | | - E Fiori
- Sapienza University of Rome, Italy
| | - A Alunno
- Sapienza University of Rome, Italy
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Bracchi M, van Halsema C, Post F, Awosusi F, Barbour A, Bradley S, Coyne K, Dixon-Williams E, Freedman A, Jelliman P, Khoo S, Leen C, Lipman M, Lucas S, Miller R, Seden K, Pozniak A. British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2019. HIV Med 2020; 20 Suppl 6:s2-s83. [PMID: 31152481 DOI: 10.1111/hiv.12748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - Clare van Halsema
- North Manchester General Hospital, Liverpool School of Tropical Medicine
| | - Frank Post
- King's College Hospital NHS Foundation Trust
| | | | | | | | | | | | | | - Pauline Jelliman
- Royal Liverpool and Broadgreen University Hospital Trust, NHIVNA
| | | | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London School of Hygiene and Tropical Medicine
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Jang JH, Jeon D, Kim YS, Cho WH, Yeo HJ. Superior Vena Cava Syndrome Due to Mediastinal Tuberculous Lymphadenitis. Korean J Fam Med 2017; 38:166-168. [PMID: 28572894 PMCID: PMC5451452 DOI: 10.4082/kjfm.2017.38.3.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 01/21/2023] Open
Abstract
Superior vena cava (SVC) syndrome refers to a medical emergency resulting from compression of the SVC. It requires early diagnosis and treatment, and is usually caused by malignant tumors; rarely, mediastinal tuberculous lymphadenitis can cause SVC syndrome. Here, we present a case study of an immunocompetent 61-year-old woman who presented with acute onset SVC syndrome and was diagnosed with tuberculous lymphadenitis on thoracotomy; the symptoms resolved with anti-tuberculosis therapy. This unusual case highlights the importance of the differential diagnosis in patients presenting with acute onset SVC syndrome; a timely diagnosis and appropriate treatment lead to complete recovery.
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Affiliation(s)
- Jin Ho Jang
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Seong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Woo Hyun Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hye Ju Yeo
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Kabra S, Mandal A, Singh A, Seth R. Superior mediastinal syndrome secondary to Pott's spine in a child. Lung India 2017; 34:487-489. [PMID: 28869243 PMCID: PMC5592770 DOI: 10.4103/0970-2113.213826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pozniak AL, Coyne KM, Miller RF, Lipman MCI, Freedman AR, Ormerod LP, Johnson MA, Collins S, Lucas SB. British HIV Association guidelines for the treatment of TB/HIV coinfection 2011. HIV Med 2011; 12:517-24. [PMID: 21951595 DOI: 10.1111/j.1468-1293.2011.00954.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A L Pozniak
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD, UK.
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Superior mediastinal syndrome due to intrathoracic tuberculosis. Indian J Pediatr 2010; 77:1021-3. [PMID: 20814840 DOI: 10.1007/s12098-010-0147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
A 5-year-old boy presented with fever, cough, breathlessness and facial swelling. He was pale with distended veins over neck and chest, cervical and axillary lymphadenopathy and bilateral expiratory wheeze. Chest radiographs showed superior mediastinal widening. A computed tomography scan of the chest revealed mediastinal lymph nodes compressing superior vena cava and trachea. Bronchoscopy revealed nodular lesions in trachea and bronchi and compression of trachea. Broncho-alveolar lavage revealed acid fast bacilli. Diagnosis of superior mediastinal syndrome (SMS) secondary to tuberculosis was made and child was treated with antitubercular treatment along with oral prednisolone with good response.
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Barshes NR, Annambhotla S, El Sayed HF, Huynh TT, Kougias P, Dardik A, Lin PH. Percutaneous stenting of superior vena cava syndrome: treatment outcome in patients with benign and malignant etiology. Vascular 2008; 15:314-21. [PMID: 17976332 DOI: 10.2310/6670.2007.00067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.
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Affiliation(s)
- Neal R Barshes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Pozniak AL, Miller RF, Lipman MCI, Freedman AR, Ormerod LP, Johnson MA, Collins S, Lucas SB. BHIVA treatment guidelines for tuberculosis (TB)/HIV infection 2005. HIV Med 2005; 6 Suppl 2:62-83. [PMID: 16011537 DOI: 10.1111/j.1468-1293.2005.00293.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A L Pozniak
- Chelsea and Westminster NHS Healthcare Trust, London, UK.
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Michailidis C, Pozniak AL, Mandalia S, Basnayake S, Nelson MR, Gazzard BG. Clinical characteristics of IRIS syndrome in patients with HIV and tuberculosis. Antivir Ther 2005; 10:417-22. [PMID: 15918332 DOI: 10.1177/135965350501000303] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some patients with HIV/tuberculosis (TB) coinfection who are on anti-TB treatment and highly active antiretroviral therapy (HAART) will develop an exacerbation of symptoms, signs or radiological manifestations of TB that are not due to relapse or recurrence of their TB. The aetiology of these immune reconstitution inflammatory syndrome (IRIS) reactions is unknown but it is presumed that they occur, at least in part, as a consequence of HAART-related reconstitution of immunity. METHODS Patients who were diagnosed with their first episode of definitive or presumed TB between January 2001 and July 2003 were identified from the Chelsea and Westminster TB/HIV database. The patients were classified into those who developed IRIS and those who did not using a set definition of the syndrome. Demographic, clinical and laboratory data relating to both HIV and TB were compared between the two groups. RESULTS A total of 55 cases of TB were identified, of which 45 cases were confirmed on culture or gene probe and 10 were presumed cases. Fourteen cases (25.5%) developed IRIS with a median (range) duration of 2.53 (0.53-14.97) months. The median baseline CD4 [interquartile range (IQR)] for the IRIS group was significantly lower at 80 (33-117) cells/mm3 (P = 0.05) than the non-IRIS group at 139 (77-284) cells/mm3. A significantly greater proportion of patients in the IRIS group [11/14 (78.60%), P = 0.011] had baseline CD4 < 100cells/mm3 compared with the non-IRIS group [16/41 (39.0%)]. There was no significant difference between the two groups when comparing the log10 baseline viral load (VL). Eight (57.0%) patients in the IRIS group had disseminated TB at baseline compared with seven (17.0%) in the non-IRIS group (P = 0.006). In those who had a detectable VL at baseline, the median fold change (IQR) in CD4 from baseline to 3 months was significantly higher in the IRIS group patients, 1.5 (0.6-5.6), compared with 0.7 (-0.2 to 1.0) for those in the non-IRIS group (P = 0.046). CONCLUSIONS Patients who develop IRIS are more likely to present with disseminated TB, have a CD4 count < 100 cells/mm3 and have a prompt rise in CD4 count in the initial 3 months of HAART.
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Roca B. Intradural extramedullary tuberculoma of the spinal cord: a review of reported cases. J Infect 2005; 50:425-31. [PMID: 15907551 DOI: 10.1016/j.jinf.2004.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 07/19/2004] [Indexed: 10/26/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare modality of tuberculosis, with only a few cases described so far. Here we review 22 reports of the disease found in the literature of the last 25 years. IETSC is closely associated with tuberculous meningitis (TM). Both conditions may occur simultaneously, but more frequently IETSC is preceded by TM. IETSC has been described in a predominantly young population of both genders. The pathogenesis is unknown, although a paradoxical reaction to antituberculous medication is a reasonable possibility. The disease presents insidiously with paraparesis, hypoesthesia with a sensory level, and bladder dysfunction, due to cord involvement or compression by the inflammatory process. Permanent paraparesis is a common sequela. MRI is the diagnostic technique of choice in IETSC. Prompt surgical excision of the tuberculoma is the cornerstone of therapy. Antituberculous treatment is also indicated; unless resistance is present, conventional chemotherapy is probably enough. Corticosteroids are also generally recommended. In conclusion, IETSC is a rare complication of TM, which presents insidiously, despite adequate antituberculous treatment. To avoid the permanent disability that this condition may provoke, an early diagnosis and prompt treatment is critical.
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Affiliation(s)
- Bernardino Roca
- Infectious Disease Division, Department of Medicine, Hospital General of Castellon, Castellon, Spain.
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Buckingham SJ, Haddow LJ, Shaw PJ, Miller RF. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy. Clin Radiol 2004; 59:505-13. [PMID: 15145720 DOI: 10.1016/j.crad.2003.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 11/24/2003] [Accepted: 12/03/2003] [Indexed: 10/26/2022]
Abstract
AIM To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV "viral load". Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients-severe enough to produce tracheal compression in two patients (one of whom had stridor)-and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started.
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Affiliation(s)
- S J Buckingham
- Department of Imaging, University College London Hospitals NHS Trust, London, UK
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Kappes S, Kunz M, Klautke G, Terpe H, Gross G. [Facial edemas in a 61-year old patient]. DER HAUTARZT 2002; 53:625-8. [PMID: 12432900 DOI: 10.1007/s00105-002-0392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Kappes
- Klinik und Poliklinik für Dermatologie und Venerologie der Universität Rostock, Germany.
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Eyer-Silva WA, Pinto JFC, Arabe J, Morais-De-Sa CA. Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease. Rev Soc Bras Med Trop 2002; 35:59-61. [PMID: 11873263 DOI: 10.1590/s0037-86822002000100011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient.
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Affiliation(s)
- Walter A Eyer-Silva
- Department of Clinical Immunology, Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Wendel KA, Alwood KS, Gachuhi R, Chaisson RE, Bishai WR, Sterling TR. Paradoxical worsening of tuberculosis in HIV-infected persons. Chest 2001; 120:193-7. [PMID: 11451837 DOI: 10.1378/chest.120.1.193] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To determine the incidence of paradoxical worsening of tuberculosis (TB) in HIV-infected persons. DESIGN Observational cohort study. SETTING Public, urban TB clinic. PATIENTS HIV-infected persons treated for TB between January 1, 1996, and December 31, 1999, and followed through June 30, 2000. INTERVENTION Patients received standard anti-TB therapy. Antiretroviral therapy was provided by primary medical providers. Patients receiving antiretroviral therapy were given nucleoside reverse transcriptase inhibitors alone or highly active antiretroviral therapy (HAART; nucleoside reverse transcriptase inhibitors in combination with a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor). MAIN OUTCOME MEASURE Paradoxical worsening of TB. RESULTS There were 82 TB cases in 76 patients. Paradoxical worsening was identified in 6 of 82 cases (7%; 95% confidence interval, 3 to 15%). Paradoxical worsening occurred in 3 of 28 cases (11%) in patients receiving HAART and in 3 of 44 cases (7%) in patients not receiving antiretroviral therapy (p = 0.67). Cases complicated by paradoxical worsening were more likely to have both pulmonary and extrapulmonary disease at initial diagnosis than cases without paradoxical worsening (83% vs 24%; p = 0.006). TB relapse occurred in 2 of 6 cases (33%) in patients with paradoxical worsening and in 4 of 76 cases (5%) in patients without paradoxical worsening (p = 0.06). CONCLUSIONS Paradoxical worsening of TB occurred less frequently than in previous reports and was not associated with HAART. Paradoxical worsening also appeared to be associated with an increased risk of TB relapse. Further studies are warranted to better characterize the risk factors for paradoxical worsening and the appropriate duration of anti-TB therapy in patients in whom it occurs.
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Affiliation(s)
- K A Wendel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore 21287, USA.
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