Abstract
BackgroundSuperior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities. Typically, a mediastinal mass produces external compression on the superior vena cava and reduces venous return. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. Multiple scoring systems are available to assist clinicians with appropriate timing of interventions for SVC syndrome. When specific criteria are met, endovascular intervention can be beneficial to patients to prevent rapid deterioration.Case presentationA 75-year-old female with no significant past medical history presented to the emergency department with increased facial swelling, nausea and vomiting which began the night prior to presentation. The patient underwent a CT chest which revealed a 3.2 × 3.0 × 3.8 cm spiculated mass compressing the right main bronchus and right pulmonary artery. The patient was intubated and interventional radiology was consulted. The patient underwent venography which showed extensive thrombosis of the innominate veins. Rheolytic thrombectomy with AngioJet™ was performed to alleviate clot burden and minimize risk of secondary pulmonary embolism. Kissing stents were placed in the bilateral innominate veins to maintain patency after thrombectomy. After the procedure, the patient was successfully extubated and had near complete resolution of facial swelling approximately 12 h post procedure. A follow up venogram performed on post procedure day 4 showed patent bilateral subclavian, innominate, and internal jugular veins as well as a patent superior vena cava.ConclusionsAcute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient’s clinical condition necessitates treatment.
Highlights
BackgroundSuperior vena cava (SVC) syndrome occurs when drainage from the head and upper extremities becomes significantly reduced, leading to venous congestion
Superior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities
Acute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway
Summary
Superior vena cava (SVC) syndrome occurs when drainage from the head and upper extremities becomes significantly reduced, leading to venous congestion. Venography was performed which demonstrated the narrowing at the cavoatrial junction as well as extensive thrombus within the SVC, right internal jugular, left subclavian, left innominate, and left internal jugular veins with multiple collateral vessels draining centrally. The AngioJetTM thrombectomy catheter system was chosen because it facilities high dose thrombolytic infusion in a short period of time in the power pulse mode This allows rapid dubulking of thrombus to prevent iatrogenic pulmonary emboli. The 8 French AngioJetTM ZelanteDVT infusion catheter was advanced into the bilateral internal jugular veins and thrombolysis was performed using 10 mg tPA diluted in 100 mL of normal saline using the power (2019) 2:28. Venography from the left basilic and internal jugular veins demonstrated stent patency without residual thrombus. The patient was transitioned to apixaban and discharged on hospital day
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