Superior vena cava syndrome caused by a right apical tense bulla

Superior vena cava syndrome induced by lung hyperinflation in chronic obstructive pulmonary disease: a case report

BACKGROUND

Superior vena cava syndrome is rarely attributed to chronic obstructive pulmonary disease.

CASE PRESENTATION

We present the case of an 82-year-old Japanese man who experienced gradually progressive dyspnea on exertion. His physical examination revealed small vascular dilatations on his chest and upper abdominal skin characterized by blood flow from head to leg, indicating superior vena cava syndrome. Radiographic findings included lung hyperinflation with a drop-like heart on chest X-ray, and emphysematous changes on computed tomography. The superior vena cava appeared extremely narrow and slit-like, with no adjacent mass or giant bulla. Pulmonary function testing indicated a forced expiratory volume in 1 second of 0.82L (44.4% of predicted value) and a forced expiratory volume in 1 second/forced vital capacity of 31.29%. A diagnosis of chronic obstructive pulmonary disease was made. We discuss how longitudinal forces can narrow the superior vena cava, particularly when it protrudes toward the lung field due to its anatomical location in the upper mediastinum. The absence of mediastinal adipose tissue may render the superior vena cava susceptible to compression, resulting in a loss of its typical columnar structure. The protrusion of the superior vena cava toward the lung field may be a contributing factor to superior vena cava narrowing in chronic obstructive pulmonary disease.

CONCLUSION

This case represents the first reported instance of superior vena cava syndrome associated with chronic obstructive pulmonary disease, characterized by lung hyperinflation, in the absence of a giant bulla.

Rare cause of superior vena cava syndrome: a giant bulla

Superior vena cava syndrome (SVCS) is a group of symptoms caused by obstruction of superior vena cava. External compression caused by benign or malign processes is the most common physiopathology. We aim to present a 29-year-old man with non-productive cough, facial plethora and venous distention of the neck. Right apical tense bulla which was compress superior vena cava was detected and video-assisted thoracoscopic surgery applied. Our extensive search found out that only one report of SVCS secondary to bulla is available on Medline.

Superior vena cava syndrome during the treatment of pulmonary tuberculosis in an HIV-1 infected patient

Tuberculosis is nowadays an uncommon cause of superior vena cava syndrome (SVCS). We report the case of an HIV-infected patient who presented with respiratory symptoms accompanied by cervical and mediastinal lymphadenopathy. Sputum examination showed acid-fast bacilli, and treatment was instituted with isoniazid, rifampicin, pyrazinamide and ethambutol. A few days later SVCS developed, presumably as a consequence of inflammatory lymphadenitis. With corticosteroids, all symptoms disappeared. To our knowledge, no cases of SVCS provoked by this kind of paradoxical reaction have been described previously.