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Lau KK, Steinke K, Reis S, Cherukuri SP, Cejna M. Current trends in image-guided chest interventions. Respirology 2022; 27:581-599. [PMID: 35758539 PMCID: PMC9545252 DOI: 10.1111/resp.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023]
Abstract
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image‐guided procedural techniques. The image guidance allows real‐time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image‐guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
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Affiliation(s)
- Kenneth K Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Steinke
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland School of Medicine, St Lucia, Queensland, Australia
| | - Stephen Reis
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Srinivas P Cherukuri
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Manfred Cejna
- Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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2
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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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3
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Szerlip M, Singh G, Luft UC. A case of a bloated face: SVC syndrome relieved by an endovascular approach. J Interv Cardiol 2011; 25:78-81. [PMID: 21599752 DOI: 10.1111/j.1540-8183.2011.00660.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Superior vena cava (SVC) syndrome, or obstruction of blood returning from the head and upper extremities, is a syndrome that is rapidly increasing in the cardiovascular patient population due to the increasing use of transvenous devices such as permanent pacemakers, implantable cardioverter defibrillators (ICDs), and indwelling venous access devices for hemodialysis. This syndrome in the past has been seen predominately in the cancer population with malignancy being the most common reason for SVC syndrome. The management of this syndrome has largely been with a medical/supportive care approach or with surgical bypass. Given the advancement in the field of endovascular interventions and the increasing expertise in performing these procedures, an endovascular approach to relieving the SVC obstruction is rapidly becoming the treatment of choice for these patients. We describe a case of a patient who had a chronic indwelling port-a-cath who developed SVC syndrome, which was treated with an endovascular approach with stenting of the SVC/brachiocephalic vein junction.
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Affiliation(s)
- Molly Szerlip
- University of Arizona, Sarver Heart Center, Tucson, Arizona 85724, USA.
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4
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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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5
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Ganeshan A, Quen Hon L, Warakaulle DR, Morgan R, Uberoi R. Superior vena caval stenting for SVC obstruction: Current status. Eur J Radiol 2009; 71:343-9. [DOI: 10.1016/j.ejrad.2008.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 04/15/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
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6
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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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7
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Abstract
Superior vena cava syndrome can occur from benign conditions that might not alter life expectancy. Here we present a case of a superior vena cava (SVC) obstruction caused by soft tissue encircling the SVC, which was strongly suspected of being an unusual focal type of fibrosing mediastinitis. A 39-year-old man with no prior medical history presented with a four-week history of facial plethora, headache and dilated veins of the neck with a dark purple color change on the anterior chest wall. Radiology examinations, including venography, and computed tomography with a 3-dimensional volume-rendering image of the chest, had revealed severe narrowing of the SVC due to tiny encircling soft tissue and collateral vessels. A total occlusion of the SVC occurred as a result of a thrombus that developed within 1 day after the diagnostic SVC angiogram. The patient underwent stent deployment three days after the administration of thrombolytic therapy.
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Affiliation(s)
- Dae Hyeok Kim
- Department of Internal Medicine, College of Medicine Inha University, Incheon, Korea.
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8
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Copeland B, Aljitawi O, Fitzgerald SM, Chi DS, Krishnaswamy G. A patient with facial and neck swelling, dyspnea, and dysphagia. Ann Allergy Asthma Immunol 2006; 95:510-7. [PMID: 16400888 DOI: 10.1016/s1081-1206(10)61011-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Billy Copeland
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee 37614-1709, USA
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9
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Sheikh MA, Fernandez BB, Gray BH, Graham LM, Carman TL. Endovascular stenting of nonmalignant superior vena cava syndrome. Catheter Cardiovasc Interv 2005; 65:405-11. [PMID: 15945106 DOI: 10.1002/ccd.20458] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior vena cava (SVC) syndrome is associated with advanced malignancy of the chest. Extensive experience is published in the literature regarding the use of endovascular intervention for symptomatic relief in these individuals with limited survival. Symptomatic SVC obstruction may occur from benign conditions that may not alter life expectancy. There are few data regarding endovascular therapy in this setting. We retrospectively analyzed our experience using endovascular intervention for benign SVC obstruction in 19 patients. In our series, the mean age was 46.4 years; 58% were female and 14/19 cases were due to an intravascular device. All patients experienced symptomatic relief. Median follow-up was 28.8 months. Three patients required secondary procedures to maintain patency. Four patients had procedural complications, which did not affect the outcomes. One patient died from complications of anticoagulation at 24 months. Endovascular procedures aimed at relieving SVC stenosis seem to be effective in patients with benign disease.
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Affiliation(s)
- M A Sheikh
- Section of Vascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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10
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Joshi LM, Singh SK, Siddiqui MS, Pandey S, Chandra G, Mehrotra A, Tandon S. Bronchogenic cyst presenting as superior vena caval syndrome: A case report. Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Madan AK, Allmon JC, Harding M, Cheng SS, Slakey DP. Dialysis Access-Induced Superior Vena Cava Syndrome. Am Surg 2002. [DOI: 10.1177/000313480206801016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vascular thrombosis is a complication of dialysis access and thrombosis of the superior vena cava by indwelling dialysis catheters access can cause superior vena cava syndrome. We describe a case of superior vena cava syndrome resulting from a dialysis access catheter placed in the internal jugular vein. Although surgical intervention is often needed to treat dialysis access-related superior vena cava syndrome this patient required only conservative measures for resolution of the syndrome. In this paper we describe the presentation, diagnosis, and management of this case. A review of dialysis access thrombosis complications and treatment options is also presented.
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Affiliation(s)
- Atul K. Madan
- Department of Surgery, University of Tennessee, Memphis, Tennessee
| | - Jon C. Allmon
- Departments of Surgery, Tulane University Medical Center, New Orleans, Louisiana
| | - Michael Harding
- Radiology, Tulane University Medical Center, New Orleans, Louisiana
| | - Stephen S. Cheng
- Departments of Surgery, Tulane University Medical Center, New Orleans, Louisiana
| | - Douglas P. Slakey
- Departments of Surgery, Tulane University Medical Center, New Orleans, Louisiana
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12
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Sharafuddin MJ, Sun S, Hoballah JJ. Endovascular management of venous thrombotic diseases of the upper torso and extremities. J Vasc Interv Radiol 2002; 13:975-90. [PMID: 12397118 DOI: 10.1016/s1051-0443(07)61861-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Central venous thrombosis in the upper torso can be either primary, occurring as a result of longstanding extrinsic compression, or secondary, resulting from an acquired intrinsic occlusive disease or foreign body. As in lower extremity deep vein thrombosis (DVT), anticoagulation therapy is the mainstay of therapy in upper torso and upper extremity DVT. However, in the presence of severely symptomatic acute thrombosis, pharmacologic and/or mechanical thrombolytic therapy represent the main invasive form of therapy for these conditions. After clearance of the acute thrombotic component, definitive management in patients with underlying anatomic abnormalities can be undertaken. Primary subclavian axillary vein thrombosis caused by extrinsic obstruction at the thoracic outlet is treated with thrombolytic therapy and anticoagulation followed by surgical decompression, whereas secondary causes of central venous obstruction and thrombosis are usually amenable to endovascular treatment with balloon angioplasty and stent placement. Postoperative interval anticoagulation is usually recommended. In addition to clinical follow-up, imaging follow-up with duplex sonography or conventional venography is usually recommended to assess the presence of restenosis and/or residual compression.
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Affiliation(s)
- Melhem J Sharafuddin
- Department of Radiology, University of Iowa College of Medicine, 3889 JPP, 200 Hawkins Drive, Iowa City, Iowa 52242-1077, USA.
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13
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Yamagami T, Nakamura T, Kato T, Iida S, Nishimura T. Hemodynamic changes after self-expandable metallic stent therapy for vena cava syndrome. AJR Am J Roentgenol 2002; 178:635-9. [PMID: 11856689 DOI: 10.2214/ajr.178.3.1780635] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We examined changes in hemodynamics after self-expandable metallic stent placement in the vena cava. CONCLUSION The rapid increase in venous return immediately after expandable metallic stent placement influenced the hemodynamics of the circulatory system.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
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14
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Fernandez B, Smolley LA, Swirsky SM, Kaye MD. Relief of sleep apnea after intravascular stenting for superior vena cava syndrome. Vasc Med 2001; 4:33-6. [PMID: 10355868 DOI: 10.1177/1358836x9900400106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rarely reported association of sleep apnea and superior vena cava stenosis from mediastinal fibrosis is described. A case is presented where substantial improvement in the sleep parameters and the symptoms of sleep apnea occurred subsequent to superior vena cava thrombolysis and stent angioplasty.
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Affiliation(s)
- B Fernandez
- Department of Vascular Medicine, Cleveland Clinic Florida, Ft. Lauderdale 33309, USA
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15
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Guerrero A, Hoffer EK, Hudson L, Schuler P, Karmy-Jones R. Treatment of pulmonary artery compression due to fibrous mediastinitis with endovascular stent placement. Chest 2001; 119:966-8. [PMID: 11243985 DOI: 10.1378/chest.119.3.966] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We present the case of a 32-year-old woman with high-grade right pulmonary artery stenosis secondary to fibrous mediastinitis. The patient was managed with balloon angioplasty and stent placement. Only 15 cases of this nature have been reported in the literature, and this is one of the first to be managed with endovascular stent placement.
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Affiliation(s)
- A Guerrero
- Department of Surgery, Harborview Medical Center, Seattle, WA 98104, USA
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16
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Othmani S, Bahri M, Louzir B, Borhan K, Bahri M. [Mediastinal fibrosis combined with Behçet's disease. Three case reports]. Rev Med Interne 2000; 21:330-6. [PMID: 10795325 DOI: 10.1016/s0248-8663(00)88935-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Intrathoracic manifestations other then vascular aneurysm and thrombosis are rare in the course of Behçet's disease. Mediastinal fibrosis is also unusual. METHODS Three cases of Behçet's disease with initial mediastinal fibrosis are reported. Diagnosis means, pathogenic mechanisms and therapeutic modalities are also more precisely defined. RESULTS Three male patients (21, 25 and 27 years of age, respectively) were hospitalized for progressive vena cava superior syndrome accompanied by mediastinal fibrosis demonstrated by MRI and/or CT scan which both showed infiltration of the mediastinal fat. Multiple calcifications were also present in one patient. Histology was performed in one case. Thrombosis of the vena cava superior and innominata veins was associated with fibrosis in all three cases. Thrombosis of venae subclavia and left jugularis was also present in one case. Other manifestations leading to the diagnosis of Behçet's disease were demonstrated by the patient's history and, in one case, occurred on the fourth day of hospitalization. After initiation of a treatment including corticoids, anticoagulants and colchicine, the outcome was favorable in two cases. The third patient died. CONCLUSION Mediastinal fibrosis combined with Behçet's disease has rarely been described. However, it should be included in manifestations of the disease. The causative process which might be vasculitis has to be demonstrated.
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Affiliation(s)
- S Othmani
- Service de médecine interne, hôpital militaire principal d'instruction de Tunis, Montfleury, Tunisie
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17
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Abstract
Treatment of SVC obstruction with metallic stents is a rewarding procedure. The patients have symptoms that are severe and debilitating and cause significant impairment of life-style. Stent placement rapidly alleviates the symptoms of SVC syndrome and improves the patient's quality of life. The long-term patency rates have not been established; however, in patients with SVC syndrome secondary to malignant disease, stents usually remain patent for the lifetime of the patient. Recurrences can be treated with further interventional radiographic techniques. Currently, because the long-term patency rates of SVC stents are not known, most interventional radiologists tend to treat SVC stenosis from benign causes with balloon angioplasty before placing metallic stents.
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Affiliation(s)
- C D Yim
- Department of Radiology, University of Minnesota School of Medicine, Minneapolis 55455, USA
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18
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Roy D, Thompson KC, Price JP. Benign superior vena cava syndrome due to suppurative mediastinal lymphadenitis: anterior mediastinoscopic management. Mayo Clin Proc 1998; 73:1185-7. [PMID: 9868418 DOI: 10.4065/73.12.1185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The benign superior vena cava syndrome is an uncommon medical emergency. We describe a case of the superior vena cava syndrome caused by suppurative mediastinal lymphadenitis. The organisms isolated from various cultures were group C beta-hemolytic Streptococcus, Fusobacterium species, Corynebacterium species, Eikenella corrodens, and Streptococcus milleri. These anaerobic bacteria are part of the normal flora of the upper respiratory tract and the oral cavity. Anterior mediastinoscopy through the right parasternal approach was used to drain the anterior mediastinal abscess and to establish the etiologic factor.
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Affiliation(s)
- D Roy
- Department of Internal Medicine, Providence Hospital, Southfield, Michigan, USA
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19
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Andrade-Filho AS, Figueirôa FS, Santiago-Figueirôa CL, Silveira DB, Andrade-Souza YM, Bandeira ER, Souza AP, Silva AG. [Transient ischemic attacks in a patient with superior vena cava obstruction: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 1998; 56:491-3. [PMID: 9754435 DOI: 10.1590/s0004-282x1998000300023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The superior vena cava obstruction is a relatively rare condition. We report the case of a 42 year old man suffering of hypertension for about fifteen years. He reported a cervical and thoracic pain for one year, that was related to a 95% of occlusion on the right coronary artery. An angioplasty has been done but the patient still related the thoracic pain. Afterwards the patient had recurrent episodes of right hemiplegia and hypertensive emergencies that have been treated with anti-hypertensive agents. A venous disease was suspected because of cyanosis in the face especially when episodes of transient ischemic attacks occurred. A venography showed obstruction of the right jugular vein near the junction with the superior vena cava. In conclusion, it was not possible to define with certainty the relationship between the two pathologies presented by the patient, even so, we call attention to the improvement of the neurological symptoms after the control of superior vena cava obstruction with the treatment.
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Affiliation(s)
- A S Andrade-Filho
- Departamento de Neuropsiquiatria da Faculdade de Medicina da Universidade Federal da Bahia (FM/UFBA), Hospital Santa Isabel, Salvador BA, Brasil
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20
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Seelig MH, Oldenburg WA, Klingler PJ, Odell JA. Superior vena cava syndrome caused by chronic hemodialysis catheters: autologous reconstruction with a pericardial tube graft. J Vasc Surg 1998; 28:556-60. [PMID: 9737469 DOI: 10.1016/s0741-5214(98)70145-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Superior vena cava (SVC) syndrome caused by long-term use of indwelling catheters is an infrequent but increasingly common complication. Because collateralization often is sufficient, surgical treatment rarely is indicated. We present a case of a patient with severe symptomatic SVC syndrome as a result of the long-term use of indwelling hemodialysis catheters. The SVC was reconstructed with a pericardial tube graft. Magnetic resonance angiography performed 13 months after the operation showed patency of the graft. The patient continues to be free of symptoms.
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Affiliation(s)
- M H Seelig
- Department of Surgery, Mayo Clinic Jacksonville, Fla 32224, USA
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21
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Abstract
Enlargement of the thyroid is common, especially in areas of endemic iodine deficiency. Substernal enlargement of a goitre can cause compression of several mediastinal structures. As a consequence of tracheal compression and tracheomalacia, syndromes of chronic respiratory distress occur and intercurrent upper respiratory infections may lead to acute respiratory failure. Superior vena cava syndrome secondary to compression by a substernal goitre may be complicated by venous thrombosis. Although dysphagia is the most frequent oesophageal symptom of a substernal goitre, upper gastrointestinal bleeding from 'downhill' oesophageal varices may be an initial presentation. Arterial compression or thyrocervical steal syndrome by large substernal goitres occasionally cause cerebral hypoperfusion and stroke. Recurrent and phrenic nerve palsies, as well as Horner's syndrome, occur secondary to non-malignant mediastinal goitres and may resolve after surgery. Substernal goitres rarely cause therapy-resistant pleural effusions, chylothorax and pericardial effusion. In conclusion, although cervical goitres are easily recognised, the initial presentation of mainly substernal goitres may be unusual.
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Affiliation(s)
- H J Anders
- Medizinische Poliklinik, Ludwig-Maximilians-University, Munich, Germany
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22
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Strimlan CV. Superior vena cava obstruction in cystic fibrosis. Chest 1998; 113:1732-3. [PMID: 9631830 DOI: 10.1378/chest.113.6.1732-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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De Cock C, Stooker W, Visser CA. Unusual approach of a pacemaker electrode in a patient with a silent superior vena cava syndrome. Pacing Clin Electrophysiol 1998; 21:1167-9. [PMID: 9604254 DOI: 10.1111/j.1540-8159.1998.tb00168.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A man with a history of bilateral pectoral pocket infection and subsequent pacemaker implantation with a screw-in epicardial lead was referred because of increasing lead impedance. Venography revealed bilateral total occlusion of the subclavian and innominate veins with extensive collateral formation in this asymptomatic patient. Both internal jugular veins were also totally occluded. Because repeated pacemaker implantation using epicardial leads resulted in increasing lead impedance of the ventricular lead within 1 year after implant, an alternative approach was found using the superior caval vein with minimal invasive thoracotomy for single lead VDD pacing.
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Affiliation(s)
- C De Cock
- Department of Cardiology, Academic Hospital VU, Amsterdam, The Netherlands. cardiol@ azvu.nl
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24
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Abstract
A woman with persistent pacemaker induced superior vena cava syndrome was stable for 10 years. Serial follow-up venography, however, demonstrated a continuous process of major vein occlusion and the development of collateral circulation, the effectiveness of which warrants a favorable prognosis in this pacemaker related syndrome.
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Affiliation(s)
- H Kataoka
- Department of Internal Medicine, Nishida Hospital, Oita, Japan
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25
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Smith SJ, Vyborny CJ, Hines JL. Re: chronic superior vena cava occlusion related to fibrosing mediastinitis treated with self-expanding shunts. Cardiovasc Intervent Radiol 1997; 20:161-2. [PMID: 9030512 DOI: 10.1007/s002709900128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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26
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Hoffmann V, Ysebaert D, De Schepper A, Colpaert C, Jorens P. Acute superior vena cava obstruction after rupture of a bronchial artery aneurysm. Chest 1996; 110:1356-8. [PMID: 8915247 DOI: 10.1378/chest.110.5.1356] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A patient was referred to our hospital with a superior vena cava syndrome after the rupture of a bronchial artery aneurysm. To our knowledge, this complication has not been reported before. An urgent thoracotomy was performed after embolization had failed.
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Affiliation(s)
- V Hoffmann
- Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium
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27
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Odev K, Ozer F, Ceran S, Karabacakoğlu A, Vural A. CT diagnosis of granulomatous mediastinitis due to tuberculosis. Eur J Radiol 1996; 23:241-6. [PMID: 9003933 DOI: 10.1016/s0720-048x(96)00764-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K Odev
- Department of Radiology, Selçuk University, School of Medicine, Konya, Turkey
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28
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Neuzil KM, Mitchell HC, Loyd JE, Lagerstrom CF, Hammon JW, Graham BS. Extrapulmonary thoracic disease caused by Blastomyces dermatitidis. Chest 1994; 106:1885-7. [PMID: 7988217 DOI: 10.1378/chest.106.6.1885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A case of blastomycosis is reported involving the mediastinum and compromising the plexus brachialis. The pathology, pathophysiology, and treatment of this patient and of a previously reported patient are discussed and compared with the characteristics of extrapulmonary thoracic disease caused by histoplasmosis. Because of the favorable response of these patients to prolonged antifungal therapy, blastomycosis should be considered in the differential diagnosis of invasive extrapulmonary thoracic disease.
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Affiliation(s)
- K M Neuzil
- Department of Medicine, Vanderbilt University School of Medicine, Nashville 37232
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29
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Dodds GA, Harrison JK, O'Laughlin MP, Wilson JS, Kisslo KB, Bashore TM. Relief of superior vena cava syndrome due to fibrosing mediastinitis using the Palmaz stent. Chest 1994; 106:315-8. [PMID: 8020305 DOI: 10.1378/chest.106.1.315] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Relief of superior vena cava (SVC) syndrome due to non-neoplastic mediastinal disease presents a formidable challenge. Long-term patency of surgically created bypass grafts has been poor, and the morbidity associated with these procedures is substantial. We report a case of SVC syndrome, caused by fibrosing mediastinitis, treated with Palmaz balloon expandable intravascular stents. Intravascular stents are a promising alternative for relief of non-neoplastic SVC obstruction.
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Affiliation(s)
- G A Dodds
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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30
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Nemoto T, Terada Y, Matsunobe S, Tsuda T, Shimizu Y. Superior vena cava syndrome caused by a right apical tense bulla. Chest 1994; 105:611-2. [PMID: 8306777 DOI: 10.1378/chest.105.2.611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Superior vena cava (SVC) syndrome is caused by several diseases, although to our knowledge, a bullous lesion has not been reported previously. In the present case, severe pleural adhesion prevented the expanding bulla from stretching the visceral pleura and from compressing the residual lung, subsequently causing compression of the SVC and thus SVC syndrome.
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Affiliation(s)
- T Nemoto
- Respiratory Center, Shiga Health Insurance Hospital, Otsu, Japan
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31
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Ohara T, Fukushima K, Hasegawa T, Kitamura S, Kawai T. Giant benign mesenchymoma of the mediastinum causing superior vena cava syndrome: report of a case. Surg Today 1993; 23:917-9. [PMID: 8298238 DOI: 10.1007/bf00311372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The surgical resection of a giant primary mediastinal mesenchymoma causing superior vena cava syndrome is herein described. A 53-year-old man was admitted to the hospital complaining of severe dyspnea. A chest roentgenogram showed a large mediastinal mass shadow compressing the superior vena cava. At surgery, a yellow tumor measuring 27 x 25 x 12 cm and weighing 3,620 g was resected. The histological diagnosis was benign mesenchymoma. The patient's postoperative course was uneventful with a successful resolution of his superior vena cava syndrome.
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Affiliation(s)
- T Ohara
- Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, School of Medicine, Tochigi, Japan
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32
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Abstract
Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. Acute cases of SVC syndrome have been described, with the majority of these being precipitated by thrombosis after central venous catheterization. The authors report a case of acute SVC syndrome after central venous catheter placement, which was not due to thrombosis, but rather caused by a catheter occluding a previously subclinical stenosis of the SVC. Resolution of the clinical SVC syndrome occurred after catheter withdrawal.
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Affiliation(s)
- T C Woodyard
- Department of Surgery, United States Air Force Medical Center, Wright-Patterson Air Force Base, Dayton, Ohio
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33
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Abstract
We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.
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Affiliation(s)
- D J Mathisen
- General Thoracic Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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34
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Ozyilkan O, Unlu E, Tekuzman G, Ruacan S, Baltali E, Firat D. Superior vena cava syndrome: Experience at the Hacettepe Medical Center. Ann Saudi Med 1992; 12:587-9. [PMID: 17588038 DOI: 10.5144/0256-4947.1992.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O Ozyilkan
- Hacettepe University, School of Medicine, Department of Internal Medicine, Oncology, and Pathology, Ankara, Turkey
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35
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Ajarim DS. Superior vena caval obstrution: King Khalid University Hospital experience. Ann Saudi Med 1992; 12:52-6. [PMID: 17589129 DOI: 10.5144/0256-4947.1992.52] [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] [Indexed: 11/22/2022] Open
Abstract
A five year experience in 21 patients with superior vena caval obstruction (SVCO) was reviwed. SVCO was due to benign conditions in four patients (19%) and malignant tumors in 17 patients (81%). Lymphoma and lung cancer were the most common causes encountered. The most common symptoms and signs were facial swelling, shortness of breath, jugular venous distention, swelling of face and arms, and engorgement of thoracic veins. Benign disorders had a longer duration of symptoms before presentation and required longer time to make the diagnosis than in malignant disorders. No serious complications resulted from the superior vena cava obstruction itself or the investigate procedures leading to the diagnosis. Prognosis and response to treatment were dependent on the underlying cause of SVCO. Chemotherapy was effective in induction of complete regression of SVCO in the majority of patients with underlying malignant disorders. We conclude that SVCO should be approached invasively for diagnosis and tissue diagnosis of the underlying disorder should dictate the appropriate therapy.
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Affiliation(s)
- D S Ajarim
- Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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36
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Lobo Beristain J, Catón Santaren B. ¿Mediastinitis fibrosa de curso dual o evolución desde granulomatosis mediastínica? Arch Bronconeumol 1991. [DOI: 10.1016/s0300-2896(15)31398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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37
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Park JY, Chung-Park M, Snow M. Intravascular papillary endothelial hyperplasia of superior vena cava: a rare cause of the superior vena cava syndrome. Thorax 1991; 46:272-3. [PMID: 2038738 PMCID: PMC463100 DOI: 10.1136/thx.46.4.272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The superior vena cava syndrome associated with an intraluminal vascular proliferative lesion is extremely rare. A case of intravascular papillary endothelial hyperplasia of the superior vena cava causing obstructive symptoms is reported that was successfully managed by surgical excision.
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Affiliation(s)
- J Y Park
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
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38
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Abstract
The superior vena cava (SVC) syndrome is usually associated with advanced malignancy and has a dismal prognosis. In order to analyze the impact of newer diagnostic and therapeutic modalities, we retrospectively examined the last 45 consecutive cases of SVC syndrome treated over a 12-year period. The underlying causes were advanced lung cancer (57%), mediastinal tumors (20%), and metastatic solid malignancy (5%). Forty-two patients (93%) were treated with external beam radiotherapy and/or chemotherapy with a mean patients survival of 3 months; 11 of 42 patients (26%) were treated without histologic diagnosis. Symptoms of SVC obstruction resolved in 80% of patients who underwent radiotherapy, with a mean interval of 4 weeks. The most common cause of death was respiratory arrest. Of the three patients with benign disease, two underwent caval reconstruction with greater than 3-year patency and relief of symptoms. We conclude that (1) SVC syndrome portends a grim prognosis when associated with malignancy but usually responds to radiation or chemotherapy; (2) CT scan is the best available method to document the extent and location of involvement; and (3) patients with benign disease should be evaluated for caval reconstruction, which may produce rewarding long-term results.
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Affiliation(s)
- J C Chen
- Department of Surgery, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance 90509
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39
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40
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Dunn EJ, Ulicny KS, Wright CB, Gottesman L. Surgical implications of sclerosing mediastinitis. A report of six cases and review of the literature. Chest 1990; 97:338-46. [PMID: 2404701 DOI: 10.1378/chest.97.2.338] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sclerosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The cause of this disorder is probably an abnormal fibroproliferative response to an inflammatory stimulus, most commonly a granulomatous infection secondary to Histoplasma capsulatum. The pathophysiology of this disease is predicated on the encasement of mediastinal vital organ structures within a dense fibrotic mass. This mass appears to emanate from an invasive chronic inflammatory process causing erosion as well as external compression of these structures. The following case reports illustrate the diversity of this disease entity, representing a patient population from the Ohio River Valley, endemic for histoplasmosis. The purpose of this report is to elucidate the various clinical manifestations of sclerosing mediastinitis and to correlate the pathologic process with a rational approach to treatment.
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Affiliation(s)
- E J Dunn
- Jewish Hospital of Cincinnati, Ohio
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41
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Castaneda F, Moradian G, Hunter D, Castaneda-Zuniga W, Amplatz K. Percutaneous intravascular biopsy using a Simpson atherectomy catheter: technical note. Cardiovasc Intervent Radiol 1989; 12:342-3. [PMID: 2516778 DOI: 10.1007/bf02575436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The design of the Simpson atherectomy catheter makes this device a potentially safe and technically easy tool to obtain adequate pathologic intravascular or intraluminal specimens. The risk of perforation should be low, but this use has to be further studied. We describe the first intravascular biopsy performed with the Simpson catheter.
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Affiliation(s)
- F Castaneda
- Department of Radiology, University of Minnesota Hospitals and Clinics, Minneapolis 52242
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42
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Affiliation(s)
- A Wurtz
- Clinique Chirurgicale Ouest, Hôpital Claude Huriez, Lille, France
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43
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Affiliation(s)
- J W Yedlicka
- Department of Radiology, University of Minnesota, Minneapolis
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44
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Tovi F, Hirsch M, Gatot A. Superior vena cava syndrome: presenting symptom of silent otitis media. J Laryngol Otol 1988; 102:623-5. [PMID: 3411218 DOI: 10.1017/s0022215100105900] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An extensive lateral sinus thrombosis secondary to silent otitis media, in a patient with a nephrotic syndrome, is presented. The thrombotic process progressed asymptomatically until the occlusion of the superior vena cava. Removal of the intractable pathology within the mastoid and administration of appropriate antibiotic therapy, prevented the further propagation of the life-threatening condition.
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Affiliation(s)
- F Tovi
- Department of Ear, Nose and Throat, Soroka University Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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45
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Abstract
This paper presents the clinical features and problems in the management of 34 patients with substernal goitre. Complete evaluation of the mediastinum relied on computed tomography. Thyroid function tests were performed routinely and showed a clinically underestimated incidence of hyperthyroidism (44 per cent). The incidence of occult malignancy in substernal goitres was high (12 per cent). In the majority of patients (88 per cent) the substernal goitres were removed by a collar incision. Four cases of goitres located in a retrotracheal position required a combined cervical and sternotomy approach. None of the 34 patients died. Transient postoperative hypocalcaemia was found in 41 per cent of our patients. The presence of a substernal goitre is an indication for resection based on the risk of malignancy, the risk of acute respiratory distress, the high incidence of thyrotoxicity and a low surgical morbidity.
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Affiliation(s)
- L A Michel
- Surgical Service, Academic Hospital (UCL), Mont-Godinne, Yvoir, Belgium
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46
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Aghaji MAC, Nnabuko REE. Life threatening superior vena caval obstruction complicating pregnancy. J OBSTET GYNAECOL 1988. [DOI: 10.3109/01443618809151366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Cosmo L, Haponik EF, Darlak JJ, Summer WR. Neoplastic superior vena caval obstruction: diagnosis with percutaneous needle aspiration. Am J Med Sci 1987; 293:99-102. [PMID: 3031983 DOI: 10.1097/00000441-198702000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Obstruction of the superior vena cava arises from a spectrum of etiologies that include both benign and malignant conditions. Therefore, management of this serious disorder varies and depends on the underlying cause. Pursuit of a histologic diagnosis with invasive procedures has been associated with a wide range of diagnostic yields and complications. Percutaneous fine-needle aspiration biopsy has been shown to be highly reliable and well tolerated in the diagnosis of a variety of mediastinal and lung masses. Three patients are presented with obstruction of the superior vena cava in whom computed tomography safely guided percutaneous needle biopsy in obtaining a correct histologic diagnosis. It appears that transthoracic percutaneous needle aspiration biopsy is safe and efficacious in patients with superior vena cava syndrome, but further experience with this increasingly available procedure is warranted.
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48
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Abstract
Histoplasmosis is a ubiquitous disease in endemic areas that has a generally subclinical course. Excessive inflammatory response may bring some patients to the attention of a thoracic surgeon to exclude malignancy of a noncalcified pulmonary or mediastinal mass or to relieve compression of specific structures. Mediastinal granuloma or fibrosing mediastinitis may involve the superior vena cava, pulmonary vessels, heart and pericardium, tracheobronchial tree, or esophagus. The cases of 94 recently treated patients are presented as well as a review of the American surgical literature. The current use of computed tomography, the time and extent of operative intervention, and the role of antifungal therapy are important to an overall understanding of the surgical treatment of the manifestations of histoplasmosis.
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49
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Nieto AF, Doty DB. Superior vena cava obstruction: clinical syndrome, etiology, and treatment. Curr Probl Cancer 1986; 10:441-84. [PMID: 3757550 DOI: 10.1016/s0147-0272(86)80006-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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50
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Sculier JP, Evans WK, Feld R, DeBoer G, Payne DG, Shepherd FA, Pringle JF, Yeoh JL, Quirt IC, Curtis JE. Superior vena caval obstruction syndrome in small cell lung cancer. Cancer 1986; 57:847-51. [PMID: 3002590 DOI: 10.1002/1097-0142(19860215)57:4<847::aid-cncr2820570427>3.0.co;2-h] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a series of 643 patients with small cell lung cancer (SCLC), 55 patients (8.6%) had signs or symptoms of superior vena caval obstruction syndrome (SVCO). Relatively long intervals from the onset of the first symptoms of SVCO to the start of therapy were observed, and invasive diagnostic procedures were safely performed in most patients. The pretreatment characteristics of patients with SVCO were not significantly different from those of patients without signs of the syndrome, and survival was similar in both groups. Patients with SVCO were usually treated first with induction chemotherapy, and prompt resolution of signs and symptoms occurred in the majority. Radiation was effective in controlling SVCO at relapse or after failure of initial chemotherapy. It was concluded that SVCO in patients with SCLC should be treated initially with systemic chemotherapy, as for other presentations of this disease. The current data do not support the commonly held view that SVCO in SCLC should be approached as an oncologic emergency.
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