Clinical and Radiological Grading of Superior Vena Cava Obstruction

Abstract

Background: Superior vena cava obstruction (SVCO) is commonly caused by neoplastic venous compression and presents with typical symptoms and signs. Its clinical severity presumably depends on the degree of obstruction and the adequacy of venous collateral formation. Objectives: The development of novel clinical and radiological scoring systems based on the postulate that a reproducible relationship exists between the degree of SVCO, the presence of collateral circulation and the extent of clinical symptoms. Methods: We prospectively evaluated consecutive cases of acute and subacute SVCO with a newly developed clinical scoring system, which is based on easily detectable clinical symptoms and signs of SVCO. In parallel, we recorded and scored the degree of SVCO and the extent of collaterals visible on contrast-enhanced computed tomography (CT). Results: Thirty-four cases of SVCO were evaluated: 8 (23.5%) were clinically mild, 16 (47%) moderate and 10 (29.5%) severe. Lung cancer was the underlying histological diagnosis in 94% of cases. Radiologically, 53% had complete SVCO. A well-developed collateral system was found in 14 (41%). A scoring system subtracting a ‘collateral score’ from an ‘obstruction score’ showed a significant correlation with the clinical score (r = 0.75, p < 0.01). Conclusions: Clinical severity of SVCO depends upon the degree of SVCO and is ameliorated by collateral formation. The novel clinical scoring system can predict the underlying CT features in SVCO and may be valuable in the bedside assessment of SVCO severity.

Diagnostic yield and safety of ultrasound-assisted biopsies in superior vena cava syndrome

“…The findings of the present study support earlier recommendations with regard to the early utilisation of contrasted CT scans in patients who present with suspected SVC obstruction secondary to malignant disease [1,4,[29][30][31]. A CT scan can confirm SVC obstruction and the presence of an intrathoracic mass lesion [1,[29][30][31].…”

“…Intrathoracic neoplasms, mainly bronchogenic carcinomas and lymphomas, are by far the most common causes [1][2][3]. An SVC syndrome secondary to an intrathoracic neoplasm is generally considered an oncological emergency that requires an expedient diagnostic evaluation and initiation of treatment [1,4]. Bronchoscopy and associated procedures have a reported diagnostic yield of .70% in this setting, whereas mediastinoscopy or mediastinotomy have a diagnostic yield of .90% [5,6].…”

Endovascular stenting to treat obstruction of the superior vena cava

“…Scoring systems that correlate clinical grading and radiological grading of severity of obstruction may help identify patients most likely to benefit from stent placement. 16 …”

Superior vena cava syndrome: a case report of a rare form of presentation

“…3 Early diagnosis and treatment with diuretics and oxygen can produce temporary symptom relief and glucocorticoids may be useful in shrinking lymphoma masses but of no benefit in lung cancer. Radiation therapy is the treatment Department of General Medicine, M. K. C. G. Medical College and Hospital, Berhampur, Odisha, India of choice for SVCS caused by non-small cell lung cancer and chemotherapy for small cell carcinoma of lung.…”