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Rijal A, Shrestha A, Chaudhary S, Shrestha A. Superior vena cava syndrome in a child with mediastinal mass: A case report. Clin Case Rep 2022; 10:e6647. [PMCID: PMC9684690 DOI: 10.1002/ccr3.6647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/17/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Facial puffiness as a consequence of superior vena cava syndrome (SVCS) can be a presentation from which the physician would have to conjecture a diagnosis of a mediastinal mass including lymphomas. Pediatric SVCS can rapidly progress and pose a greater challenge for airway protection as was in our case. Pediatric superior vena cava syndrome (SVCS) due to malignancy can be a rapidly progressive life‐threatening condition that leads physicians to decide between choosing either immediate therapeutic management or further diagnostic procedures considering the case at hand.
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Affiliation(s)
- Ashes Rijal
- Tribhuwan University, Institute of MedicineKathmanduNepal,Nepal Health FrontiersKathmanduNepal
| | - Anish Shrestha
- Tribhuwan University, Institute of MedicineKathmanduNepal
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Nossair F, Schoettler P, Starr J, Chan AKC, Kirov I, Paes B, Mahajerin A. Pediatric superior vena cava syndrome: An evidence-based systematic review of the literature. Pediatr Blood Cancer 2018; 65:e27225. [PMID: 29781569 DOI: 10.1002/pbc.27225] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Superior vena cava syndrome (SVCS) results in vascular, respiratory, and neurologic compromise. A systematic search was conducted to determine the prevalence of pediatric SVCS subtypes and identify clinical characteristics/treatment strategies that may influence overall outcomes. Data from 101 case reports/case series (142 patients) were analyzed. Morbidity (30%), mortality (18%), and acute complications (55%) were assessed as outcomes. Thrombosis was present in 36%, with multi-modal anticoagulation showing improved outcome by >50% (P = 0.004). Infant age (P = 0.04), lack of collaterals (P = 0.007), acute complications (P = 0.005), and clinical presentation may have prognostic utility that could influence clinical decisions and surveillance practices in pediatric SVCS.
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Affiliation(s)
- Fadi Nossair
- Division of Oncology, CHOC Children's, Orange, California
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Peter Schoettler
- Department of Pediatrics, University of California-Irvine, Irvine, California
- Department of Pediatrics, CHOC Children's, Orange, California
| | - Joanne Starr
- Division of Cardiothoracic Surgery, CHOC Children's, Orange, California
| | - Anthony K C Chan
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Kirov
- Division of Oncology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
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Lung cancer with superior vena cava syndrome diagnosed by intravascular biopsy using EBUS-TBNA. Respir Med Case Rep 2016; 19:177-180. [PMID: 27812495 PMCID: PMC5078677 DOI: 10.1016/j.rmcr.2016.10.009] [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: 08/31/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022] Open
Abstract
Since superior vena cava syndrome (SVCS) is a critical condition, immediate diagnostic approach and therapy are imperative to avoid potentially life-threatening complications. Here, we report a case of lung cancer with SVCS, which was diagnosed through intravascular tumor biopsy using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS-TBNA enabled us to obtain tissue sufficient for diagnosis, without significant complications. Prompt diagnosis was followed by appropriate anticancer treatment and improvement in the symptoms. For patients suspected of SVCS and requiring prompt pathologic diagnosis, we can consider EBUS-TBNA to diagnose intravascular or mediastinal tumors and provide an accurate diagnosis.
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Jung HJ, Moon JH, Lee YN, Kim HK, Choi HJ, Choi MH, Lee TH, Cha SW. SVC syndrome managed immediately after on site diagnosis of EUS-guided sampling for metastatic small-cell carcinoma of the pancreas presenting as acute pancreatitis. Endosc Ultrasound 2015; 4:345-7. [PMID: 26643705 PMCID: PMC4672595 DOI: 10.4103/2303-9027.170433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, South Korea
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Wong MK, Tam TC, Lam DC, Ip MS, Ho JC. EBUS-TBNA in patients presented with superior vena cava syndrome. Lung Cancer 2012; 77:277-80. [PMID: 22521081 DOI: 10.1016/j.lungcan.2012.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Expedient pathological diagnosis is crucial in selection of appropriate treatment in patients presented with superior vena cava syndrome (SVCS). The performance and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in this setting is unknown. METHODS Over a 4-year period, patients presented with SVCS in the presence of mediastinal mass and referred for EBUS-TBNA were enrolled for the study. The procedure was performed under local anaesthesia with conscious sedation. TBNA was performed under real-time with the curvilinear probe of EBUS. Rapid on site cytological examination (ROSE) was not available. RESULTS Eighteen procedures of EBUS-TBNA were performed in 17 patients. Malignancy was confirmed in 16 patients (diagnostic yield 94.1%). There was no major complication including significant bleeding or pneumothorax related to the procedures. CONCLUSIONS EBUS-TBNA has high diagnostic yield and is safe in patients presented with SVCS and mediastinal mass.
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Affiliation(s)
- Matthew K Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Rami-Porta R, Call S. Invasive staging of mediastinal lymph nodes: mediastinoscopy and remediastinoscopy. Thorac Surg Clin 2011; 22:177-89. [PMID: 22520285 DOI: 10.1016/j.thorsurg.2011.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nodal status in lung cancer is essential for planning therapy and assessing prognosis. The involvement of ipsilateral and contralateral mediastinal lymph nodes is associated with poor prognosis and usually excludes patients from upfront surgical treatment. Mediastinoscopy is a time-honored procedure that allows the surgeon to access the upper mediastinal lymph nodes for either biopsy or removal. Remediastinoscopy is mainly indicated to assess objective tumor response in mediastinal lymph nodes after induction therapy for locally advanced lung cancer and to indicate further therapy.
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Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, University of Barcelona, Plaza Drive Robert 5, 08221 Terrassa, Barcelona, Spain.
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Pop D, Venissac N, Nadeemy AS, Guiraudet P, Mouroux J. Video-assisted mediastinoscopy in superior vena cava obstruction: to fear or not to fear? J Thorac Oncol 2011; 7:386-9. [PMID: 22139391 DOI: 10.1097/jto.0b013e3181e50457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We investigate the safety and efficacy of video-assisted mediastinoscopy (VAM) used for diagnosis of the superior vena cava syndrome. METHODS In a 7-year period, we have done 447 VAM for malignant causes. We have compared, in a retrospective study from a prospectively maintained database, the differences between the groups with (first group) or without (second group) superior vena cava syndrome in terms of operative time, preoperative and postoperative complications, and results of pathologic examination. Statistical differences between the groups were calculated by χ2 test. RESULTS Mean operative time for first (31 patients) and second (416 patients) groups was 18 and 34 minutes, respectively (p < 0.00). Mean hospital stay was 1.2 days in both the groups. Mortality rates for the first and second groups were 0 and 0.5% (p = 0.31); major morbidity rates were 0 and 0.7% (p = 0.50); and minor morbidity rates were 6.4 and 1.7% (p = 0.27), respectively. In the superior vena cava syndrome group, most of the lymph nodes biopsied were in paratracheal superior sites (81%); histology showed small cell lung cancer in 51.6%, non-small cell lung cancer in 25.8%, and lymphoma in 22.6%. CONCLUSIONS VAM represents an important diagnostic tool in superior vena cava syndrome. Once decided to be used, we think that video technique is a good option with high rate of efficacy and low rates of mortality and morbidity.
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Affiliation(s)
- Daniel Pop
- Thoracic Surgery Department, Pasteur Hospital, Nice, France.
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García Salido A, Nieto Moro M, Casado Flores J. Dificultad respiratoria en el niño con cáncer. Med Intensiva 2011; 35:562-8. [DOI: 10.1016/j.medin.2011.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 06/09/2011] [Indexed: 11/16/2022]
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Brundyn K, Koegelenberg CFN, Diacon AH, Louw M, Schubert P, Bolliger CT, van den Heuvel MM, Wright CA. Transbronchial fine needle aspiration biopsy and rapid on-site evaluation in the setting of superior vena cava syndrome. Diagn Cytopathol 2011; 41:324-9. [PMID: 22102539 DOI: 10.1002/dc.21857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/07/2011] [Indexed: 11/06/2022]
Abstract
There is a paucity of prospective data on flexible bronchoscopy with rapid on-site evaluation (ROSE) in the setting of superior vena cava (SVC) syndrome. The aims of this prospective study were to assess the diagnostic yield and safety of these investigations and specifically to evaluate the role of ROSE in limiting the need for tissue biopsies. Over a 5-year period 48 patients (57.4 ± 9.7 years) with SVC syndrome secondary to intrathoracic tumors underwent flexible bronchoscopy with TBNA and ROSE. Endobronchial Forceps biopsy was reserved for visible endobronchial tumors with no on-site confirmation of diagnostic material. ROSE confirmed diagnostic material in 41 cases (85.4%), and in only one of the remaining cases did the addition of a forceps biopsy increase the diagnostic yield (overall diagnostic yield of 87.5%). No serious complications were noted. The final diagnoses made included nonsmall lung cancer (n = 27), small cell lung cancer (n = 16), and metastatic carcinoma (n = 3). Two undiagnosed cases died of suspected advanced neoplasms (unknown primary tumors). We conclude that TBNA has a high diagnostic yield and is safe in the setting of SVC syndrome. With the addition of ROSE, tissue biopsy is required in the minority of cases.
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Affiliation(s)
- K Brundyn
- Division of Anatomical Pathology, Department of Pathology, University of Stellenbosch and National Health Laboratory Services, Cape Town, South Africa
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Medford ARL. Endobronchial ultrasound-guided transbronchial needle aspiration in patients with superior vena cava obstruction. Thorac Cancer 2011; 2:221-223. [PMID: 27755852 DOI: 10.1111/j.1759-7714.2011.00071.x] [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: 02/05/2023] Open
Abstract
Lung cancer is commonly encountered by community and hospital services and patients may present with early signs of superior vena cava obstruction (SVCO). SVCO requires prompt but minimally invasive investigation to avoid bleeding and for prompt treatment. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) provides respiratory physicians with a less invasive technique to sample mediastinal lymph nodes at bronchoscopy, avoiding the need for general anesthesia and mediastinoscopy, and allowing real-time imaging and sampling of the nodes. It is therefore safer than conventional bronchoscopic techniques of sampling the nodes (transbronchial needle aspiration), reducing the risk of bleeding. If neck ultrasound biopsy is unhelpful in SVCO, then EBUS-TBNA should be considered as the best initial option, reserving mediastinoscopy for a last resort. A clinical case is described here to demonstrate the use of EBUS-TBNA in SVCO. EBUS-TBNA is a safe and effective mediastinal sampling tool in patients with SVCO and should be considered before mediastinoscopy or conventional TBNA in this setting. This study adds shoes there should be more emphasis on the use of EBUS-TBNA in the diagnosis of mediastinal disorders in settings where higher bleeding is anticipated, including SVCO.
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Affiliation(s)
- Andrew R L Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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Samphao S, Eremin JM, Eremin O. Oncological emergencies: clinical importance and principles of management. Eur J Cancer Care (Engl) 2011; 19:707-13. [PMID: 20030695 DOI: 10.1111/j.1365-2354.2009.01091.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Oncological emergencies are common conditions associated with significant morbidity and mortality. Delay in diagnosis and treatment can result in unfavourable outcomes. Cancer itself, cancer-related hormones or cytokines, or treatment effects can cause emergency problems. Febrile neutropaenia, frequently associated with chemotherapy, can lead to life-threatening conditions. Treatment requires systematic evaluation and early empirical antibiotics. Hypercalcaemia of malignancy is the most common metabolic emergency in cancer patients. Non-specific clinical features may cause delay in diagnosis and increase morbidity and mortality. Treatment includes active fluid resuscitation, diuretics and intravenous bisphosphonates. Superior vena cava syndrome is usually caused by external compression. Computerised tomography is useful to confirm diagnosis, evaluate the extent of disease and guide invasive tissue diagnosis. Treatment and prognosis depend on the underlying malignancies. Spinal cord compression is a true emergency due to risk of permanent neurological impairment. Localised back pain is the most common presenting symptom while late presentation of neurological deficit is associated with irreversible outcomes. Magnetic resonance imaging is the investigation of choice. Treatment includes corticosteroids, radiotherapy and/or decompressive surgery.
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Affiliation(s)
- S Samphao
- Research and Development Department, Lincoln County Hospital, Lincoln, UK.
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Thakker M, Keteepe-Arachi T, Abbas A, Barker G, Ruparelia N, Kingston GT, Parke TJ. A primary cardiac sarcoma presenting with superior vena cava obstruction. Am J Emerg Med 2011; 30:264.e3-5. [PMID: 21277135 DOI: 10.1016/j.ajem.2010.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 11/23/2010] [Indexed: 11/29/2022] Open
Abstract
Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are non–small cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic. The diagnosis of SVC obstruction secondary to a primary cardiac sarcoma was established based on clinical, radiologic, and post-mortem findings. This is one of very few reported cases of a primary cardiac sarcoma causing SVC obstruction.
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Affiliation(s)
- Manish Thakker
- ST4 in Emergency Medicine, Department of Emergency Medicine, Stoke Mandeville Hospital, Aylesbury, UK.
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Liu B, Zhi X, Xu Q, Zhang Y, Su L, Chen D, Wang R, Hu M, Liu L, Qian K. [Application of videomediastinoscopy in positive PET finding for mediastinal lymph node of lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:168-70. [PMID: 20673513 PMCID: PMC6000525 DOI: 10.3779/j.issn.1009-3419.2010.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/09/2009] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Positron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. However, the role of PET in mediastinal lymphatic staging of NSCLC is not clear. The aim of this study was to demonstrate the efficacy of mediastinoscopy in determining mediastinal lymphatic metastasis in cases of positive PET finding. METHODS We performed PET preoperatively in 68 patients with clinically operable NSCLC between 2003 and 2008. Mediastinal lymphatic defined as metastasis by PET (SUV(max) > 2.5) was recorded. Mediastinoscopy being performed initially in all patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results. RESULTS From 2003 to 2008, 61 mediastinoscopy were performed. There were 38 men and 23 women, aged from 41 to 81 years (mean 60 years). Localization of the tumor was right lung in 41 patients and left lung in 20 patients. After the operation, 45 patients were demonstrated to have N2 or N3 disease. Ten patients with N3 mediastinal metastasis for chemotherapy, 38 patients with N2 mediastinal metastasis for neuadjuvant chemotherapy while lung resection and systemic mediastinal lymphatic dissection through thoracotomy was performed in the remaining 16 patients with no mediastinal metastasis. The positive prediction value of PET scan was 73.8% (45/61). The sensitivity, specificity, accuracy, positive prediction value and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 93.8% (45/48), 100% (13/13), 95.1% (58/61), 100% (45/45), 81.3% (13/16) for mediastinoscopy, respectively. CONCLUSION PET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Lung Cancer Certer, Capital Medical University, Beijing 100053, China.
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D'Andrilli A, Venuta F, Rendina EA. Surgical Approaches for Invasive Tumors of the Anterior Mediastinum. Thorac Surg Clin 2010; 20:265-84. [DOI: 10.1016/j.thorsurg.2010.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Civilini E, Melissano G, Bertoglio L, Chiesa R. Collateral pathways visualization of the innominate vein. J Vasc Surg 2010; 52:758-9. [PMID: 20045612 DOI: 10.1016/j.jvs.2009.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Efrem Civilini
- Department of Vascular Surgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
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Black KR, Eloubeidi MA. Superior vena cava syndrome: diagnosis of etiology with EUS-guided FNA. Gastrointest Endosc 2008; 67:568-70. [PMID: 18155209 DOI: 10.1016/j.gie.2007.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 08/09/2007] [Indexed: 02/08/2023]
Affiliation(s)
- Katherine R Black
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356:1862-9. [PMID: 17476012 DOI: 10.1056/nejmcp067190] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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