Early Thrombosis of the Superior Vena Cava in a Patient with a Central Venous Catheter and Carcinoma of the Ampulla of Vater

Abstract

Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. The diagnosis is suggested by the clinical manifestations of facial and upper extremity swelling, dyspnea, and cough. It is confirmed by CT scan showing the development of collateral flow around the lesion. In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.

Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

“…Only few papers have investigated the role of CT. Forneris reported on the use of helical CT in 18 hemodialyzed patients with a complicated indwelling internal jugular vein catheter (21). Cannon et al reported a case of CT-diagnosed superior vena cava thrombosis developing a short period after central venous catheterization and surgery for adenocarcinoma of Vater ampulla (22). Aggarwal and McCauley described a case of superior vena cava syndrome diagnosed by CT in a patient with tunneled CVD-induced thrombosis (23).…”