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