Cava Syndrome Research Articles

Bronchogenic cyst presenting as superior vena caval syndrome: A case report

Superior vena cava (SVC) obstruction most often is caused by int ra thoracic ma l ignan t process e.g. Bronchogenic carc inoma and lymphomas . The Commonest cause of benign superior vena cava (SVC) obstruction is fibrosing mediastinitis 6, which accounts for 10% of overall cases. Here we report an unusual presentation of right apical bronchogenic cyst 4 presenting as a superior vena cava syndrome, which was successfully operated at our institution. of upper lobe compressing superior vena cava. (Fig.2). Sputum test for Mycobacterium, and ELISA test for Echinococcus were negative, and Fine Needle Aspiration Cytology (FNAC) was inconclusive.

Budd‐Chiari and inferior caval vein syndromes due to membranous obstruction of the liver veins: successful treatment with angioplasty and transcaval transjugular intrahepatic porto‐systemic shunt

The case is presented of a 25‐year‐old Caucasian patient with Budd‐Chiari syndrome due to membranous obstruction of the liver veins and inferior caval vein syndrome as a result of secondary hyperplasia of the caudate lobe of the liver, obstructing the caval vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and liver vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic vein and subsequent transjugular intrahepatic porto‐systemic shunt (TIPS) insertion via the caval vein was successful. After 34 months of follow‐up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic vein stenosis and TIPS in Budd‐Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce liver engorgement and complications of portal hypertension in selected patients with Budd‐Chiari syndrome.

Restenosis of superior vena cava after treatment using a self-expanding metallic stent in a patient with idiopathic fibrosing mediastinitis

The use of a self-expanding metallic stent (SEMS) for the treatment of superior vena cava (SVC) syndrome arising from non-neoplastic mediastinal disease is controversial, and data on long-term clinical observations for such have not yet been accumulated. We report a case of fibrosing mediastinitis with an obstruction of the SVC 30 months after the insertion of an SEMS. The patient had a headache and temporal facial swelling when the obstruction occurred, but these symptoms disappeared within 1 month. No further treatment was required in this case.

Results of radiation therapy for thymoma based on a review of 27 patients

Background: Radiotherapy has a well recognized role as an adjuvant treatment to surgery in thymoma and remains the only available treatment, with or without chemotherapy, in unresectable tumors. Objective: Our objective is to assess the factors predicting the outcome and the pattern of survival in patients with thymoma treated by radiotherapy in our institution. Methods: Between February 1989 and October 2000, 27 patients underwent radiotherapy for thymoma and were reviewed retrospectively. A follow-up could be obtained on all 27 patients. The parameters assessed were: age, sex, stage, presenting Myasthenia gravis, resectability, treatment modalities and survival. The total radiation dose to the tumor area in the adjuvant setting was 40–60 Gy and in the curative setting: 50–70 Gy. Results: The median follow-up time of the 18 living patients was 74 months (range: 8–144 months). According to the Masaoka classification, there were 8 stage IV, 14 stage III and 5 stage II patients (three patients had relapsed tumors). There were 15 males and 12 females with a median age of 56 years. Ten patients had Myasthenia gravis at the time of presentation, two patients had pure red cell aplasia. Eighteen patients had dyspnea or superior vena caval syndrome (six of them). And five patients had only mild chest discomfort. Sixteen patients had complete surgical resection and 11 patients had partial resection (5) or only biopsy (6). Ten of them received a mean of three courses of chemotherapy with Cisplatin, Doxorubicin, and Cyclophosphamide (CAP). The overall 5 and 10 years survival rates were 65 and 47%, respectively. The 5 years survival rate for patients with complete resection was 81% compared to 44% for patients with partial resection or biopsy ( P=0.01). Patients with Myasthenia had a 5 years survival of 71% compared to 53% for non-myasthenic patients. All patients with Myasthenia had complete surgical resection. Age, sex, presence of anemia, or superior vena caval syndrome were not adverse prognostic factors. There was no difference in terms of survival between relapsed and newly diagnosed tumors or between debulking surgery and biopsy. The 2 years survival for the four patients non-responders to chemotherapy was 0% while the 5 years survival for the responders was 71% ( P=0.005). Conclusion: Resectability and response to chemotherapy for unresectable patients seem to be factors that predict the outcome in thymoma. Myasthenia gravis appears to be important in detecting the tumor when it is still resectable.

TREATMENT OF SUPERIOR VENA CAVA SYNDROME WITH RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR IN A SICKLE CELL PATIENT UNDERGOING BONE MARROW TRANSPLANTATION

Superior vena cava (SVC) syndrome is a well-recognized clinical entity seen with mediastinal malignancies and intraluminal venous thrombosis. The role of recombinant tissue plasminogen activator (rt-PA) in the resolution of SVC syndrome caused by thrombosis in the bone marrow transplant settings has not been described. The authors report a case of SVC syndrome with good clinical response in a 16-year-old female with sickle cell disease undergoing an allogeneic bone marrow transplant (BMT) from her HLA identical sibling. Shortly after her transplant, she was found to have significant facial edema and swelling above the neck. Concomitantly, her renal function deteriorated with progressive elevation of serum urea nitrogen and creatinine levels, requiring the use of continuous veno-venous hemofiltration. An upper extremity venogram showed complete SVC obstruction (type III) with apparent inferior reflux into the azygos system. rt-PA was started at a dose of (0.5 mg/kg/day) for 2 days. There was a dramatic resolution of her symptoms, including significant improvement in renal function with increase in urine output. A repeat venogram showed free flow from the distal tip of the central line consistent with a patent superior vena cava. There was no evidence of any bleeding manifestations with rt-PA. This report highlights the usefulness of rt-PA as a treatment modality for SVC syndrome in the BMT settings.

Breast varices: imaging findings of an unusual presentation of collateral pathways in superior vena caval syndrome

Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction.

Superior Vena Caval Syndrome: Color Flow Doppler Detection of Collateral Venous Channels

Thrombosis of the superior vena cava (SVC) is an important clinical problem that requires prompt diagnosis. Confirmation of suspected SVC syndrome requires the use of an imaging study to document the obstruction and presence of collateral venous channels. Echocardiography is often used to evaluate suspected SVC obstruction; however, previous methods have allowed only indirect detection of collateral flow. We describe 3 patients with SVC obstruction in whom color flow Doppler allowed direct demonstration of collateral venous channels. (J Am Soc Echocardiogr 2000;13:780-4.)

Dealing with Anger About Pain Management

A68-YEAR-OLD NAVAL MILITARY MAN was transferred to an inpatient hospice unit with pain and delirium from an acute care hospital. One month previously he had been admitted to the hospital with confusion, dysphagia, and a new neck mass. A tracheostomy was performed and laryngeal adenocarcinoma with superior vena cava (SVC) syndrome was diagnosed. Radiation therapy to the neck and mediastinum was initiated. His hospital course was complicated by an upper gastrointestinal hemorrhage and persistent bleeding diathesis, right pleural effusion, left lower lobe pneumonia, and an ischemic right lower extremity due to an occluded femoralpopliteal graft. His past medical history was remarkable for Stage I adenocarcinoma of the lung resected 4 years prior to admission, hypertension, transient ischemic attacks (TIAs) and severe peripheral vascular disease. He was married and lived with his wife. He has four adult children. He had a significant smoking and alcohol history. Examination showed a lethargic man who appeared to be in moderately severe distress. The tracheostomy was visible, but deviated by an obvious neck mass. His skin showed multiple ecchymoses. His extremities were mottled and he moaned, particularly when he was moved. His mental status was clouded but he was intermittently able to converse. The medical assessment was that the man was close to dying (days to weeks). The patient was able to verbalize that he had diffuse pain, particularly worse with movement. Intermittent opioids gave relief with some sedation. The patient’s wife insisted that no analgesics be administered. She was argumentative and hostile, particularly to the physician staff. Two sons supported this point of view. Two daughters, privately, supported the giving of adequate analgesia. Nursing staff felt angry and frustrated at not being able to relieve the patient’s physical pain.

Clinical and laboratory observations in 91 dogs infected with Dirofilaria immitis in northern Greece

The medical records of 91 dogs with heartworm (Dirofilaria immitis) infection were reviewed, and diagnoses were established by using parasitological and immunological methods. Twenty-one animals were asymptomatic (stage 1), 57...

Endovascular strategies for inferior vena cava obstruction

Inferior vena cava (IVC) syndrome is a relatively uncommon yet debilitating disorder. Traditional medical and surgical therapy has been suboptimal in dealing with this entity. Endovascular therapy depends on the nature and chronicity of the lesion, requiring correlation with presenting symptoms, noninvasive imaging findings, and angiographic findings. We present a brief review of the literature on the treatment of vena cava obstruction, as well as our experience in IVC recanalization in 17 patients with chronic obstructions. Of the 17 patients, 15 had initial technical success, with 14 of these undergoing stent deployment. At a follow-up time of up to 19 months, a primary patency rate of 80% and secondary patency rate of 87% was observed. Endovascular therapy of IVC syndrome is a promising and successful approach to the treatment of IVC syndrome, both in cases of acute obstruction due to malignant cause, as well as chronic obstruction of benign cause.

Blastomycosis granuloma involving the cranial vena cava associated with chylothorax and cranial vena caval syndrome in a dog

A four-year-old, sexually intact, male dachshund was diagnosed with pulmonary blastomycosis. Itraconazole was administered for 60 days, and the dog was considered to be disease-free at three- and 12-month reevaluations. Two years following discontinuation of itraconazole, the dog developed a granuloma of the cranial vena cava resulting in chylothorax and cranial vena caval obstruction. To the authors' knowledge, this is the first case of a blastomycotic granuloma involving the vena cava reported in the dog. Blastomycosis should be considered as a differential diagnosis for both chylothorax and cranial vena caval syndrome in the dog.

A CASE REPORT OF GIANT ADENOMATOUS GOITER WITH SUPERIOR VENA CAVAL SYNDROME

A 64-year-old woman was admitted to the hospital because of swelling of her right upper limb and neck. She had been pointed out a goiter 30 years before admission and followed at another hospital. Since she had an arteriovenous shunt in the right arm at her 61-year-old of age, her right upper limb and neck swelled gradually. Chest X-ray film showed a tumor shadow in the superior mediastinum. Magnetic resonance imaging revealed a narrow right jugular vein, which was remarkably compressed by the goiter, with stagnation of bloodstream. The patient was diagnosed as having a giant intramediastinal goiter with superior vena caval syndrome. Nearly total thyroidectomy was performed. The pathological diagnosis was adenomatous goiter. After the operation, the swelling of the right upper limb and neck disappeared. Malignant lung cancers account for most cases of superior vena caval syndrome, but on the other hand, thyroid disease account for rare cases. In this case the increase in venous pressure by the arteriovenous shunt might take part in casing the disease, too. We must also take into consideration the thyroid disease in making an arteriovenous shunt.

Plasma renin activities, angiotensin II concentrations, atrial natriuretic peptide concentrations and cardiopulmonary function values in dogs with severe heartworm disease.

Relationships among plasma renin activities (PRA), plasma angiotensin II (ATII) concentrations, atrial natriuretic peptide (ANP) concentrations and cardiopulmonary function values were examined in dogs with ascitic pulmonary heartworm disease and acute- and chronic-vena caval syndrome (CS). PRA, plasma ATII concentration and plasma ANP concentration tended to be higher or were significantly higher in dogs with ascites, acute- and chronic-CS. PRA correlated significantly with plasma ATII concentration, WBC count, ALP activity, plasma concentrations of urea nitrogen, creatinine, sodium, potassium, and chloride, right ventricular endodiastolic pressure and right atrial pressure. Plasma ATII concentration correlated significantly with WBC count, plasma concentrations of urea nitrogen, sodium, and potassium, right ventricular endodiastolic pressure and right atrial pressure. Plasma ANP concentration did not correlate with PRA or ATII concentration, but correlated significantly only with pulmonary arterial pressure.

Multimodality Treatment of Malignant Superior Vena Caval Syndrome

Malignant superior vena caval (SVC) syndrome due to non-small cell lung cancer is invariably fatal, with most therapy directed toward palliating the manifestations of the disease. A cure, by means of any modality, is unusual. We report a patient with SVC syndrome secondary to documented ipsilateral peritracheal nodal involvement (stage IIIB disease) who underwent neoadjuvant chemoradiotherapy and resection. At surgery, his superior vena cava was not involved and his tumor had been downstaged to stage I (T1 nanoseconds). He remains alive and free of disease 60 months after surgery. Neoadjuvant chemoradiotherapy may be used to downstage malignant SVC syndrome to resectable lesions in good functional candidates.

Aggressive primary mediastinal non-Hodgkin's lymphomas: a study of 29 cases.

Aggressive primary mediastinal non-Hodgkin's lymphomas (NHL) represent a particular entity among intrathoracic neoplasms. Twenty-nine patients with primary mediastinal aggressive NHL diagnosed and treated in the author's institution were studied. According to the Revised European-American Lymphoma (REAL) classification, there were 15 diffuse large B-cell, eight T-lymphoblastic, four anaplastic, one large T-cell and one Burkitt's lymphomas. The study group consisted of 14 females and 15 males, with a mean age of 38 yrs. Symptoms arose from an aggressive anterior mediastinal mass, with a high prevalence of superior vena caval syndrome, pleural, and pericardial effusions. At the time of diagnosis, disease was confined to supradiaphragmatic areas in 24 patients, while subdiaphragmatic nodal or extranodal involvement was also present in five. All patients received a combination of aggressive chemotherapy regimens, mainly according to the French protocols for the treatment of NHL. A chest radiograph response of <50% after the first course of chemotherapy and failure to achieve a complete remission after the first line of chemotherapy were significantly associated with unfavourable prognosis. Overall 5-yr and 9-yr survival rates were 55 and 48%, respectively. Patients properly diagnosed and treated with a combined modality of chemotherapy can experience prolonged survival.

Superior caval venous syndrome after atrial switch procedure: relief of complete venous obstruction by gradual angioplasty and placement of stents.

Superior caval venous syndrome is one of the late problems known to occur after Mustard repair of complete transposition. Reoperation may leave residual stenosis, and carries substantial risk for the patient. It is now feasible to use intravascular stents to overcome systemic venous baffle obstructions, and such an approach is probably more effective. The purpose of our study therefore, was to assess immediate and medium term results of inserting stents subsequent to gradual balloon enlargement of acquired atresia of the intraatrial baffle in patients who had undergone an atrial switch operation. We investigated five patients with complete obstruction of the superior caval venous pathway at perforation of the atretic segment was achieved using a guide wire technique. The procedure was successful in all patients. Gradual angioplasty was performed and intravascular stents were implanted. The pressure in the superior caval vein dropped to normal values, symptoms improved, and the patency of the newly created venoatrial communication was proven at mid-term follow-up. Thus critical obstructions at the superior caval venous pathway after the Mustard procedure can be reopened by interventional catheterization. Implantation of balloon-expandable intravascular stents is safe and effective in the acute relief of the obstructions, but careful long-term follow-up is mandatory.

Surgical management of superior vena caval syndrome in sarcoidosis

Sarcoidosis causing the superior vena caval syndrome has been only rarely documented in the literature. We report surgical management of this problem with a spiral vein graft.

Canine and feline caval syndrome

The caval syndrome is a serious complication of chronic heartworm (Dirofilaria immitis) disease in dogs and cats. The syndrome is characterized by acute anorexia, respiratory distress, weakness, right-sided cardiac murmur, anemia, hemoglobinuria, hepatic and renal dysfunction, signs of forward and backward heart failure, and, possibly, disseminated intravascular coagulation (DIC). Retrograde migration of adult heartworms from the pulmonary arteries to the right ventricle, right atrium, and venae cavae causes disruption of the tricuspid apparatus. Valvular insufficiency, with concurrent pulmonary hypertension, reduces cardiac output thus resulting in forward and backward heart failure. Additionally, red blood cells are traumatized and hemolyzed as they flow through the mass of worms. Therapy consists of supportive care and the removal of the heartworm mass from the right ventricular inflow tract. Caval syndrome in dogs and cats is associated with high mortality rates and generally has a guarded to poor prognosis.

Venous obstruction due to insertion of permanent transvenous pacemaker electrodes in children

AbstractTransvenous placement of pacemaker leads is the recommended method for permanent pacemaking in children. We evaluated 11 children with transvenous ventricular pacemaker leads by digital subtraction angiography in order to determine the incidence of venous obstruction. The ages at the implantation ranged from 4.5 to 11.2 years with a mean of 8.05±2.17 and a median of 7.9 years. The interval from implantation to the time of procedure ranged from 12 to 64 months, with a mean of 37.4±19.2 and a median of 45 months. Complete occlusion of the subclavian vein was demonstrated in two patients. We also showed significant stenosis of the venous system in five further patients. Of the 7 patients, 5 had an extensive venous collateral circulation. We did not observe obstruction of the superior caval vein, or superior caval venous syndrome. Although we did not demonstrate this syndrome, we propose future regular evaluation of all our children undergoing transvenous pacemaking. This point may be important when second or third leads are implanted.

Excision of a locally invasive thymoma causing cranial vena caval syndrome in a dog

Excision of a locally invasive thymoma causing cranial vena caval syndrome in a dog