svc syndrome sung chul hwang, m.d. dept. of pulmonary and critical care medicine ajou university...

SVC Syndrome

Sung Chul Hwang, M.D.Dept. of Pulmonary and Critical Care Medicine

Ajou University School of Medicine

Introduction

• A medical entity where compression of SVC by various causes brings clinical symptoms and signs of facial, upper body edema, formation of collateral circulations, and causes cyanosis and dyspnea

• 1757 William Hunter• Malignancy– most common• Fibrosing mediastinitis

Etiology

1) Malignancy 66/86 (YUMC)2) Mediastinal fibrosis 23) Thrombosis 14) Inflammatory 05) Radiation fibrosis 06) Unknown 31

Symptoms and Signs

1) Suffusion2) Dyspnea3) Cough4) Pain5) Neck Vein Distention6) Venous engorgement7) Edema8) Cyanosis

Diagnosis

• History• Physical Examination• X-rays and CT Scans• Tissue Diagnosis

Diagnostic Methods

• Bronchoscopy• Lymph node biopsy• Sputum cytology• Pleural biopsy• Thoracotomy• Bone marrow biopsy

Treatment of SVC Syndrome

• Radiotherapy• Chemotherapy : Small cell Ca, Lymphom

a• Diuretics• Corticosteroid• Endovascular Stents

Prognosis

•Poor• Inoperable•Not treated : 3- 4 weeks• If treated : about 10

months

SVC Invasion by Lung Cancer

SVC Invasion by Lung Cancer

SVC Syndrome and the stents

Lymphoma with SVC SD

F/26 DOE for 2 months

Lymphoma with SVC SD

Lymphoma with SVC SD

Fibrosing Mediastinitis

• 20- 40 years• Cough, Dyspnea, or Hemoptysis• Most common cause of Benign SVC syndrome• Almost always remote Histoplasmosis• Plain X-rays may be normal or only minimal ch

anges• Partially calcified Mass on CT is diagnostic

Fibrosing Mediastinitis

F/29 with SVC Syndrome by Histoplasmosis

Fibrosing Mediastinitis

F/29 with SVC Syndrome by Old Histoplasmosis