CT findings in superior vena cava obstruction

Yedlicka, Joseph W.; Schultz, Kurt; Moncada, Rogelio; Flisak, Michael E.

doi:10.1016/0037-198x(89)90029-1

Cited by 30 publications

(12 citation statements)

References 15 publications

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“…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].…”

Section: Discussionsupporting

confidence: 88%

“…A CT scan can confirm SVC obstruction and the presence of an intrathoracic mass lesion [1,[29][30][31]. Moreover, in cases where basic investigations, such as sputum cytology, supraclavicular lymph node FNA and pleural aspiration, fail to yield a diagnosis, the findings of a CT scan may guide the choice between further special investigations, chiefly bronchoscopy with TBNA (in the case of more central tumours with mediastinal lymphadenopathy) or US-assisted TTFNA where tumours abut the chest wall [23,24].…”

Section: Discussionmentioning

confidence: 99%

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

Koegelenberg¹,

Bolliger²,

Plekker³

et al. 2009

European Respiratory Journal

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The yield and safety of ultrasound (US)-assisted transthoracic fine needle aspirations (TTFNA) and cutting needle biopsies (CNB) in the setting of superior vena cava (SVC) syndrome are unknown. The aims of the present prospective study were to asses the diagnostic yield and safety of US-assisted TTFNA and CNB in SVC syndrome with an associated mass lesion abutting the chest wall.Over a 3-yr period, the present authors screened 59 patients with SVC syndrome, and enrolled 25 patients who had an associated mass lesion that extended to the chest wall. US-assisted TTFNA with rapid on-site evaluation (ROSE) was performed in all cases. CNBs were performed where a provisional diagnosis of bronchogenic carcinoma could not be established, and in 57.1% of patients with bronchogenic carcinoma (limited due to safety constraints).ROSE of US-assisted TTFNA confirmed diagnostically useful material in 24 patients, and cytological diagnoses were ultimately made in all of these cases (diagnostic yield 96%). USassisted CNB had a diagnostic yield of 87.5%. Minor haemorrhage occurred in one out of 25 TTFNA and three out of 16 CNB. Neither procedure resulted in major haemorrhage nor pneumothoraces.US-assisted TTFNA and CNB have a high diagnostic yield and are safe in the setting of SVC syndrome with an associated mass lesion abutting the chest wall.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

Koegelenberg¹,

Bolliger²,

Plekker³

et al. 2009

European Respiratory Journal

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“…A greater degree of SVCO on CT should be clinically more severe if less collateral drainage is visible, and clinically less severe if more collaterals have developed. The rationale is that congestive symptoms of SVCO are mitigated by the formation of collateral veins, which are clearly demonstrated on CT as enhancing round or tubular structures [10,11,12,13]. The major collateral pathways in SVCO are the azygos/hemiazygos system, the internal mammary and lateral thoracic veins, and the vertebral venous system [10,11,12,13].…”

Section: Methodsmentioning

confidence: 99%

“…Stridor or dyspnoea in the supine position were thought to indicate severe but not quite life-threatening SVCO and therefore scored lower (4 points). Hoarseness and dysphagia occur due to moderate oedema of the vocal cords and oesophagus [10], and scored 2 points. The individual scores were added for each case to obtain a total clinical score, which could theoretically range from 0 to a possible maximum score of 36.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnosis on CT is based on visualization of obstruction, with absent or diminished opacification of the SVC below the level of obstruction as well as opacification of collateral routes of venous drainage [9,10,11,12,13]. CT not only gives important information regarding the cause and site of obstruction, but also provides guidance regarding the most appropriate procedure for obtaining a histological diagnosis, and is useful in planning radiation portals [9, 10]. Magnetic resonance imaging is useful where contrast administration is contra-indicated [8].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Grading of Superior Vena Cava Obstruction

Plekker

Ellis²,

Irusen³

et al. 2007

Respiration

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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.

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