Difficult airway in an infant with acute Superior Vena Cava Syndrome following central venous catheterisation

Abstract

We present the case of a 40 day old term female infant with rapidly increasing swelling of the face and neck due to undiagnosed Superior Vena Cava (SVC) syndrome. We successfully intubated the trachea using a videolaryngoscope after a failed fibreoptic intubation attempt. The possibility of thrombus and inflammation resulting in SVC obstruction should be considered following previous Internal Jugular Vein (IJV) cannulation. Videolaryngoscopes, such as the paediatric C-MAC® D-Blade, can be a valuable adjunct for a difficult airway algorithm in infants.

Superior Vena Cava Syndrome in an Infant: A Case of Delayed Diagnosis

“…This blockage of blood flow may be partial or complete and results in venous congestion in the upper body, causing swelling of the face, neck, and upper extremity, difficulty breathing, cough, and dilated collateral veins in the chest [1][2][3]. Swelling of the tissues of the face and neck can be severe enough to cause airway compression and oropharyngeal obstruction [3,4]. SVC obstruction most commonly occurs as a result of compression from a nearby mass, such as mediastinal malignancies, as the vessel is thin-walled and easily flattened [3].…”

“…As a result, SVC syndrome was not initially investigated, especially as his edema seemed to fluctuate and improve with corticosteroid administration. SVC syndrome has been noted to cause significant airway obstruction and respiratory distress in pediatric cases [1,2,4]. When occluded, there is a reversal of blood flow in the SVC leading to venous congestion in the smaller tributary veins.…”

“…In children, this malignancy is most commonly non-Hodgkin’s lymphoma [ 1 ]. An increasing number of cases are being caused by non-malignant, non-compressive etiologies, particularly stenosis or thrombosis from iatrogenic sources, as devices such as pacemaker wires or catheters are being used more frequently [ 3 , 4 ].…”

“…SVC syndrome has been noted to cause significant airway obstruction and respiratory distress in pediatric cases [ 1 , 2 , 4 ]. When occluded, there is a reversal of blood flow in the SVC leading to venous congestion in the smaller tributary veins.…”

“…Nossair et al found that 9% of cases had oropharyngeal obstruction and 10% had acute airway compression, with 67% of cases experiencing dyspnea [ 2 ]. Thampi et al report a case of SVC syndrome in a 40-day-old after bilateral internal jugular vein central line placement that resulted in rapid, severe swelling of the face and neck with cyanosis that required emergent intubation to maintain the airway [ 4 ]. Thrombi in the SVC was identified and evacuated surgically.…”