Prevalence of Thromboembolic Disease IncludingSuperior Vena Cava and Brachiocephalic Veins

Anaphylaxis and superior vena cava thrombus in a pediatric patient with acute lymphoblastic leukemia

Pediatric patients with malignancies are at significant risk for complications from their underlying condition and medical therapy. Emergency medicine physicians must be quick to suspect life-threatening events, which can present insidiously. We describe a case of anaphylaxis and superior vena cava syndrome in an 18-year-old female patient after polyethylene glycol-conjugated asparaginase chemotherapy for acute lymphoblastic leukemia. Pertinent literature surrounding risk factors, diagnosis, and treatment is also reviewed.

Superior vena cava obstruction presenting as a complication of repeated central venous cannulations

Frequent use of central venous cannulations and dialysis catheters has led to increased complications like venous thrombosis and catheter-related sepsis. Superior vena cava subclavian obstruction secondary to extensive thrombosis of the central veins and internal jugular veins is presented. The risk factors, diagnostic modalities, and treatment options are discussed.

Thrombosis of the left brachiocephalic vein after subtotal esophagectomy with reconstruction using a retrosternally shifted gastric tube: Report of a case

We performed a right transthoracic subtotal esophagectomy with systemic three-field lymph node dissection, followed by reconstruction with a gastric tube shifted retrosternally into the left side of the neck, for esophageal cancer in a 62-year-old woman. The patient had an uneventful postoperative course until postoperative day (POD) 9, when a venous thrombosis originating from the left brachiocephalic vein and elongating to the left subclavian vein was detected occasionally on computed tomography scans, although there were no clinical symptoms. The left brachiocephalic vein seemed narrowed by compression from the reconstructed gastric tube, and this was considered the cause of the thrombosis. The patient was commenced on thrombolytic therapy, using urokinase, and on anticoagulation therapy, using heparin and warfarin. The thrombus had disappeared completely by POD 38. The anticoagulation therapy was continued for 6 months and no recurrence of the thrombosis has been detected in the 4 months since its completion.