Superior Vena Cava Syndrome in Conjunction with Pulmonary Vasculature Compromise: A Case Study and Literature Review

Abstract

Patient: Male, 61Final Diagnosis: SVC syndromeSymptoms: DyspneaMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Superior vena cava (SVC) syndrome can result from external compression or invasion of the vessel from structural pathology within the mediastinum. Here we present a case of a patient that had no airway compromise, but who had hemodynamic instability due to pulmonary vasculature compression requiring urgent intervention.Case Report:A 61-year-old male who presented with severe dyspnea was found to have newly diagnosed small cell carcinoma of the right lung. The carcinoma compressed the SVC as well as the right pulmonary artery (PA) as seen on computed tomography scanning. He became critically hypoxic and was emergently intubated. Due to the lack of airway compromise, this instance of SVC syndrome was not emergently treated with radiation or chemotherapy. However, he received appropriate treatment while on mechanical ventilatory support and eventually recovered.Conclusions:SVC syndrome is considered an emergent condition in the setting of airway compromise. With the addition of PA compression, a case’s acuity should be reconsidered. Our case highlights the fact that SVC syndrome can be associated with compression of the right PA, due to its close proximity to the SVC. This can lead to rapid hemodynamic deterioration, thereby increasing the acuity when evaluating a patient with SVC syndrome. We recommend emergent intervention to be taken when a patient develops this combination of SVC syndrome and PA compromise.

Superior Vena Cava Syndrome: Etiologies, Manifestations, and Treatments

“…This is especially true in a patient with concurrent pulmonary artery obstruction and in those with underlying preexisting cardiac dysfunction. 1 62 65 In patients with known concurrent pulmonary artery obstruction, pulmonary artery stenting is a potential option. In patients with suspected underlying cardiac dysfunction, preprocedural echo should be performed.…”

Superior vena cava syndrome

“…Cardiac output might be reduced in SVCS, especially in more severe and rapidly developing cases like in acute SVC thrombosis or rapidly increasing tumor compression, in cases with pre-existing chronic heart failure, and/or in cases of mass compression not only of the SVC but also of the heart and/or pulmonary artery [3,12].…”

Superior vena cava syndrome management in limited source setting: a case report

“…4 Cardiac output may be reduced, especially in rapidly developing cases like in acute SVC thrombosis, in pre existing chronic heart failure cases, and in cases with concomitant heart and/or pulmonary artery mass compression. 5 Symptoms resulting from reduced cardiac filling may present, for example hypotension and syncope; which usually occurs during coughing or bending. 1 Venous pressure increases in brachial, cervical, and cerebral veins lead to venous congestion of the head, neck, upper thorax, and arms.…”