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Superior vena cava syndrome is the Polish name for a symptom complex classified as oncological emergencies, also known as SVCS (superior vena cava syndrome). Superior vena cava syndrome most often occurs in patients suffering from neoplasms located in the area of the chest.
In the case of neoplastic diseases in which there is a significant increase in the area of the chest, problems may arise in the proper functioning of the circulatory system. Blood flowing through the veins, including the superior vena cava, can be slowed down or even inhibited.
The superior vena cava, also known as the vena cava or the vena cava, is a vast blood vessel responsible for the flow of blood from the upper part of the human body. Its diameter is approximately 20-22 mm in length. Its main tributary is the brachiocephalic veins, which combine to give rise to it. The superior vena cava is located in the thoracic region between the right superior and middle mediastinum.
The causes of the superior vena cava syndrome
Superior vena cava syndrome appears most often as a result of a tumor located in the chest. As many as 80% of patients with superior vena cava syndrome suffered from the immediate vicinity or pressure exerted by the tumor on a blood vessel. The cancers most often causing superior vena cava syndrome include: lung cancer (responsible for the vast majority of cases of superior vena cava syndrome), non-Hodgkin’s lymphomas, and metastases from these tumors to the mediastinal lymph nodes.
Less common causes of the superior vena cava syndrome are: breast cancer (and its metastases), germ cell tumor in the mediastinum, Hodgkin’s lymphoma, esophageal cancer, thyroid cancer, thymomas, pleural mesothelioma, aortic aneurysm, venous thrombosis (resulting from the use of a vascular catheter), idiopathic mediastinal fibrosis or caused by chronic inflammation of the mediastinum, tuberculosis.
Symptoms of superior vena cava syndrome
The most common symptoms that indicate the possibility of superior vena cava syndrome include:
- swelling in the upper parts of the body: head, face, neck, hands,
- bruising around the head,
- swollen jugular veins,
- reddened conjunctiva.
These symptoms are caused by blood stagnation in the superior vena cava and the upper parts of the body. Rising blood pressure also causes further symptoms:
- Headache,
- dizziness, problems with concentration and balance,
- problems with proper vision,
- breathing problems, coughing, shortness of breath,
- hoarseness, wheezing
- swallowing problems
- pain in the chest area.
As the superior vena cava syndrome develops over a long period of time, an alternative venous pathway is created to drain the blood away. The inactive blood vessel becomes visibly dilated and visible through the chest tissues.
How is superior vena cava syndrome diagnosed?
The basic examination used to diagnose the presence of superior vena cava syndrome is X-ray. An X-ray can identify potential changes to the chest tissue, such as dilation of the mediastinum or fluid accumulation in the pleural cavity. Computed tomography, magnetic resonance imaging or venography also allow the diagnosis of superior vena cava syndrome. This test additionally provides information about possible causes causing the symptoms, about the degree of narrowing or clotting of the superior vena cava. If the patient suffers from a tumor localized in the chest, it is necessary to undergo a histopathological examination. Determining the type of neoplasm responsible for the symptoms allows to plan the treatment and to predict the further development of the superior vena cava syndrome.
How is superior vena cava syndrome treated?
There are two main pathways in the treatment of superior vena cava syndrome. Treatment may be focused on relieving the symptoms accompanying the development of the disease or focusing on eliminating its causes.
The fight against the symptoms of the superior vena cava syndrome begins with the regular use of glucocorticosteroids and diuretics, which reduce the level of symptoms. The causal treatment undertaken differs in specific cases. Most often, when the cause of the superior vena cava syndrome is a neoplasm located in the thoracic region, treatment begins with radiotherapeutic procedures. The irradiated parts of the body include, first of all, the chest and its individual fragments, especially the mediastinum. Irradiation is performed immediately, and in extremely severe cases, even when a complete histopathological examination has not yet been performed. In addition, chemotherapy and angioplasty procedures are used.
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