Clinical analysis of 50 children with superior vena cava syndrome combined with malignant tumors / 中华实用儿科临床杂志

Objective:To summarize and analyze the clinical characteristics, treatment and prognosis of superior vena cava syndrome (SVCS) with malignant tumors in children, and to improve the understanding of its clinical management.Methods:Clinical data of 50 children with SVCS combined with malignant tumors treated in the First Affiliated Hospital of Zhengzhou University from November 2010 to May 2022 were analyzed retrospectively.The pathological types, clinical manifestations, imaging examination, treatment and prognosis were summarized.The overall survival (OS) rate and event-free survival (EFS) rate were evaluated by Kaplan-Meier method.Results:Among the 50 cases, 38 were males and 12 were females, with a male/female ratio of 3.2∶1.0.The median onset was 12.5 (8.0, 14.5) years, and the most common onset occurred in adolescence (66.0%, 33/50). Cough (80.0%, 40/50) was the most common clinical manifestation, followed by face and neck edema (66.0%, 33/50), chest tightness (56.0%, 28/50) and dyspnea (50.0%, 25/50). All the 50 cases were confirmed by histopathological examination, 39 cases(78.0%) were diagnosed as non-Hodgkin′s lymphoma (NHL). NHL was the most common malignant tumor, of which T-lymphoblastic lymphoma (T-LBL) accounted for 74.4%(29/39). All the 50 cases were examined by CT examination, involving 42 cases (84.0%) detected with mediastinal masses.Pleural effusion (86.0%, 43/50) and pericardial effusion (70.0%, 35/50) were common imaging findings.The 3-year OS rate and EFS rate of them were 59.7% and 57.9%, respectively.The 3-year OS rate and EFS rate of the 39 children with NHL were 62.9% and 60.9%, respectively.Conclusions:Children with malignant tumors complicated with SVCS are featured by the acute onset, rapid progress and poor prognosis.NHL is the most common cause, especially T-LBL.Cough, edema of face and neck, chest tightness and dyspnea are common clinical manifestations.Early detection and treatment contribute to save children′s lives.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft

Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

Superior vena cava syndrome management in limited source setting: a casereport

Superior vena cava syndrome (SVCS) is syndrome caused by mass compression, tumor invasion, and/or thrombosis of SVC. In the past, SVCS was mostly linked to infection. Nowadays, SVCS is mostly linked to malignant tumor and medical procedures. Most common malignant cause of SVCS is non small cell lung cancer.A 69-year-old man was presented with breathing difficulty. Symptom began 4 months before admission, with worsening of symptom since 2 weeks before admission. Symptom improved with sitting position, and worsened with supine position. Patient had been sleeping with 2 pillows. Patient had productive cough and hoarseness. Swelling of face and neck were present. Collateral vein distention was visible in the area of head, neck, and chest. Physical examination of lung revealed decreased vesicular breath sound at right side. Non pitting edemawas found at both sides of upper extremity.SVCS in this case can be categorized into grade 2, chronic SVCS case. CT showed center right lung mass, although malignant cells were not obtained from pleural puncture and CT guided needle biopsy. Staging of mass was T4N3M1a. Mass finding at the center of right lung is in accordance with the previous findings that SVCS generally arise from lung (not mediastinum), and that right sided masses are generally more likely to cause SVCS. Management in this case was done by giving corticosteroid and diuretic. Surgery, radiotherapy, and immunotherapy were not done since malignancy diagnosis hadn抰 been able to be concluded.

A case of superior vena cava syndrome

Superior Vena Cava Syndrome is the clinical manifestation of the Superior Vena Cava obstruction, with severe reduction in venous return from the head, neck and upper extremities. More than 80% cases of SVCS is nearly attributable to advanced malignancy, most commonly lung cancer. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. The most severe complications of SVC syndrome include Glottic edema and venous thrombosis in the central nervous system. We represent a case SVC syndrome due to Small Cell Cancer of the lung.

Transcatheter management of post-surgical superior vena cava obstruction

Obstruction of the superior vena cava (SVC) is a rare complication after cardiac surgery in infants and children. We present the case of a 2-year-old male child who underwent surgery to repair a mixed total anomalous pulmonary venous connection. After 18 months of surgery, the child developed SVC syndrome. Transcatheter stenting was performed to relieve the SVC obstruction detected with transthoracic echocardiography. The patient was discharged after 5 days of hospitalization. The patient was doing well at follow-up appointments, with good laminar flow through the stent. In conclusion, transcatheter management of post-surgical complications of SVC obstruction was successful in this patient.

Síndrome de vena cava superior: una serie de casos consecutivos en pacientes internados en un hospital terciario universitario / Superior vena cava syndrome: a consecutive case series of in-hospital patients in a tertiary teaching hospital

Introducción: el síndrome de vena cava superior resulta de la obstrucción del flujo sanguíneo a través de este vaso. Casi la totalidad de los casos en la actualidad se asocian con tumores malignos. Existen controversias acerca del manejo apropiado de este cuadro. Actualmente, las terapias endovasculares son consideradas de elección. Materiales y métodos: se recolectaron y describieron, a partir de datos de la historia clínica electrónica, los casos de pacientes mayores de 18 años internados ­de forma consecutiva, que desarrollaron el síndrome­ en el Hospital Italiano de Buenos Aires en 2021. Se constataron las características basales, los tratamientos recibidos y los desenlaces clínicos intrahospitaliarios de cada uno de ellos. Resultados: un total de cinco pacientes fueron incluidos en el presente estudio y seguidos durante su instancia intrahospitalaria. Todos los casos descriptos fueron secundarios a enfermedades oncológicas. La mayoría de los pacientes presentaron un cuadro de moderada gravedad según las escalas utilizadas. En cuatro de cinco pacientes se optó por terapias endovasculares y dos de ellos fallecieron durante la internación. Discusión: existen controversias respecto del tratamiento óptimo del síndrome de vena cava superior, y heterogeneidad en la práctica clínica. Los estudios futuros deberían centrarse en identificar a aquellos pacientes que más probablemente se beneficien de las estrategias terapéuticas endovasculares, anticoagulantes o antiagregantes. (AU)

Introduction: superior vena cava syndrome results from an obstruction of blood flow through this vessel. Currently, almost all cases are associated with malignancies. There are controversies about the optimal management of this syndrome. Endovascular therapies are considered the first-line therapy. Material and methods: we collected clinical, laboratory and pharmacological data from patients admitted at the Hospital Italiano de Buenos Aires, between January 1st and November 1st 2021 with a diagnosis o superior vein cava syndrome. Baseline characteristics, treatment strategies and clinical outcomes were recorded. Results: a total of five patients were included in the present study. All cases were malignancy-related. Most of the patientsdeveloped moderate symptoms. Four out of five patients were treated with endovascular therapies and two patients died during hospitalization. Discussion: controversies regarding optimal management of the superior vena cava syndrome remain. Future research should focus on identifying those patients who are most likely to benefit from endovascular, anticoagulant or antiplatelet therapeutic strategies. (AU)

Risk factors analysis of hypotension in patients with hemodialysis-related superior vena cava diseases / 中华肾脏病杂志

Objective:To explore the risk factors of hypotension in patients with hemodialysis-related superior vena cava diseases.Methods:This was a retrospective cohort study. The maintenance hemodialysis patients diagnosed as superior vena cava stenosis ≥50% or occlusion in West China Hospital of Sichuan University from January 1, 2019 to March 31, 2022 were selected. The patients were divided into hypotensive group and non-hypotensive group according to the occurrence of hypotension during non-dialysis period. The differences of general clinical data, cardiac ultrasound parameters and blood biochemical indexes between the two groups were compared. Multivariate logistic regression model was used to analyze the risk factors of hypotension in patients with hemodialysis-related superior vena cava lesions.Results:A total of 202 patients with hemodialysis-related superior vena cava lesions were included, of whom 84 patients (41.6%) developed hypotension during non-dialysis. Compared with the non-hypotensive group, patients in the hypotensive group had longer dialysis age ( Z=2.093, P=0.036), shorter left atrial diameter ( t=2.316, P=0.022), lower aortic valve orifice flow rate ( t=3.702, P=0.001) and serum calcium ( t=2.320, P=0.021), thicker left ventricular posterior wall ( t=3.042, P=0.003), lower proportions of hypertension history ( χ2=9.125, P=0.003), and higher proportion of residual superior vena cava ≤30% or occlusion ( χ2=8.940, P=0.003) and azygous vein opening ( χ2=11.067, P=0.001). Multivariate logistic regression analysis results showed that no history of hypertension ( OR=0.383, 95% CI 0.156-0.943, P=0.037), slow aortic valve orifice flow ( OR=0.207, 95% CI 0.062-0.695, P=0.011) and low blood calcium ( OR=0.236, 95% CI 0.066-0.841, P=0.026) were the independent influencing factors of hypotension in patients with hemodialysis-related superior vena cava diseases. Conclusions:Hemodialysis patients with severe stenosis or occlusion of the superior vena cava during non-dialysis have a higher risk of hypotension. No history of hypertension, slow aortic valve orifice flow, and low blood calcium are the independent risk factors of hypotension in patients with hemodialysis-related superior vena cava diseases.

Síndrome de vena cava superior en pediatría. Una revisión de la literatura / Superior vena cava syndrome in pediatrics. A review of the literature

Las urgencias oncológicas son un reto para el clínico. El síndrome de vena cava superior es una emergencia hemato-oncológica en pediatría, el cual se define como la obstrucción intrínseca o extrínseca de la vena cava superior. La clínica más frecuente en pediatría es la aparición de circulación colateral, edema en esclavina y cianosis facial. El diagnóstico es clínico y debe hacerse lo menos invasivamente posible y de una manera rápida, para iniciar cuanto antes su manejo. Los linfomas, el uso prolongado de catéter venoso central y la cirugía cardiovascular en cardiopatías congénitas, son las principales etiologías. En algunas ocasiones, puede ser necesario un tratamiento empírico para salvar la vida del paciente, mediante el uso de esteroides y radioterapia. El objetivo del presente artículo es revisar y actualizar los aspectos más importantes sobre la etiología, las manifestaciones clínicas, el diagnóstico y el tratamiento del síndrome de vena cava superior en pediatría

Oncological emergencies are a challenge for the clinician. The superior vena cava syndrome is a hemato-oncological emergency in pediatrics; it is defined as an intrinsic or extrinsic obstruction of the superior vena cava. The most frequent clinical manifestations in children are the appearance of collateral circulation, edema in the body and facial cyanosis. The diagnosis is clinical and should been done as little invasively as possible and without delay to start its management as soon as possible. Lymphomas, prolonged use of a central venous catheter, and cardiovascular surgery in congenital heart disease are the main etiologies. In some cases, empirical treatment may be necessary to save the patient's life, through the use of steroids and radiotherapy. The aim of this article is to review and update the most important aspects of the etiology, clinical manifestations, diagnosis and treatment of the superior vena cava syndrome in pediatrics

Tratamiento intervencionista con stent para el síndrome de vena cava superior con complicación por el uso de marcapasos en un lactante / Stent interventional treatment of superior vena cava syndrome with a pacemaker placement complication in an infant

Resumen Introducción: El marcapasos epicárdico es el método preferido en recién nacidos y niños que pesan menos de 10 kg. Sin embargo, su colocación cuenta con una alta incidencia de fracaso prematuro. Caso clínico: Se presenta el caso de un lactante que requirió la colocación de un marcapasos por bloqueo atrioventricular congénito diagnosticado prenatalmente. El paciente presentaba estenosis crítica de la vena cava superior como complicación secundaria a los cables del marcapasos. La resolución intervencionista mediante un stent en el sitio de estenosis corrigió el síndrome de vena cava superior de forma efectiva. Conclusiones: Este caso representa una alternativa clínicamente viable en el tratamiento del síndrome de vena cava superior, que puede emplearse después de otras terapias convencionales que hayan fallado.

Abstract Background: Epicardial pacemaker is the preferred method for newborns and children under 10 kg of weight. However, its placement presents a high rate of premature failure. Case report: The case of an infant requiring placement of pacemaker by congenital atrioventricular block with prenatal diagnosis is described. The patient showed critical stenosis of the superior vena cava as a complication. Interventional resolution using a stent at the site of stenosis corrected the superior vena cava syndrome effectively. Conclusions: This case represents a clinically viable alternative for the treatment of superior vena cava syndrome, which can be used after other conventional therapies have failed.

Tumor mediastinal de células germinales en un paciente con melanoptisis / Mediastinal germ cell tumor in a patient with melanoptysis / Tumor de células germinativas mediastinais em paciente com melanoptise

Figuras A Y B: Radiografía de Tórax Anteroposterior (AP) y Lateral. Presencia de gran lesión al parecer del mediastino medio (Flechas blancas), con diámetros de 11 x 15 x 12 cm, de densidad homogénea, con efecto de masa y desviación de todas las estructuras (Flechas negras) y compresión sobre el lóbulo superior derecho (*), sin calcificaciones en su interior. Figura C. Tomografía computarizada de tórax con contraste corte coronal. En la región central del mediastino anterior, se identifica una masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, de 14.3 x 10.2 x 12.6 (Línea amarilla) cm, que se encuentra desplazando la aorta ascendente, con trayecto tortuoso (Flecha azul), la flecha roja señala el tronco braquiocefálico. Figura D. Tomografía computarizada de tórax corte axial en ventana mediastinal. Masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, la cual se encuentra desplazando y ocupando gran parte de la porción anterior del hemitórax derecho. Así mismo se encuentra desplazando estructuras mediastinales como el tronco de la pulmonar (Flecha azul), esta masa se encuentra generando atelectasia pasiva del lóbulo medio derecho (Flecha roja). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Figures A and B: Anteroposterior (AP) and Lateral Chest X-ray. Presence of a large mass, apparently from the middle mediastinum (white arrows), diameters of 11 x 15 x 12 cm, homogeneous density, with the mass effect on other mediastinal structures (black arrows) and compression on the right upper lobe (*), without inner calcifications. Figure C. Chest Computed Tomography, coronal section. In the anterior mediastinum it shows a hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, diameters of 14.3 x 10.2 x 12.6 (yellow line) cm, displacing the ascending aorta (blue arrow), the red arrow indicates the brachiocephalic trunk. Figure D. Computed tomography of the chest, axial section. Hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, which occupying a large parto f the anterior right hemithorax. It is also displacing mediastinal structures such as the trunk of the pulmonary artery (blue arrow), this mass is generating passive atelectasis of the right middle lobe (red arrow). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Figuras A e B: Radiografia de tórax (anteroposterior (AP) e lateral). Presença de grande massa, aparentemente do mediastino médio (Setas brancas), diâmetros de 11 x 15 x 12 cm, densidade homogênea, com efeito de massa em outras estruturas mediastinais (setas pretas) e compressão no lobo superior direito (*), sem calcificações internas. Figura C. Tomografia computadorizada de tórax, corte coronal. No mediastino anterior, mostra uma massa hipodensa e heterogênea, com predominância da densidade de partes moles, com algumas calcificações internas, diâmetros de 14,3 x 10,2 x 12,6 (Linha amarela) cm, deslocando a aorta ascendente (seta azul), a seta vermelha indica o tronco braquiocefálico. Figura D. Tomografia computadorizada de tórax, corte axial. Massa hipodensa, heterogênea, com predominância da densidade de partes moles, com algunas calcificações internas, que ocupam grande parte do hemitórax anterior direito. Também está deslocando estruturas mediastinais, como o tronco da artéria pulmonar (Seta azul), essa massa está gerando atelectasia passiva do lobo médio direito (Sseta vermelha). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Mild Presentation of Superior Vena Cava Syndrome in a Patient with Non-Small Cell Lung Cancer: A Case Report

@#Superior vena cava (SVC) syndrome can be fatal if not discovered early. Most SVC syndrome presentations are related to malignancies; lung cancer in particular. The presentations may vary, depending on severity of SVC obstruction. We report a case of mild SVC syndrome of a 70-year-old gentleman who presented with a one-month history of intermittent plethora and facial puffiness. Computed tomography scan of the chest revealed superior mediastinal mass which may represent matted lymph nodes obstructing SVC with bilateral pleural and pericardial effusion. Biopsy of the mass was done, and non-small cell lung carcinoma was diagnosed. Clinical presentation, differential diagnoses and issues relating to SVC syndrome were discussed with the emphasis on early recognition of mild symptoms and prompt management.

Leiomiosarcoma de la vena cava superior con extensión a las cavidades cardíacas derechas / Leiomyosarcoma of the superior vena cava with extension to the right heart cavities

RESUMEN Fundamento: el leiomiosarcoma de la vena cava superior es una enfermedad rara y más cuando se extiende a las cavidades cardíacas. Objetivo: presentar una paciente con leiomiosarcoma de la vena cava superior que se extendió de forma intraluminal a las cavidades derechas del corazón lo que provocó obstrucción de las mismas y choque cardiogénico. Caso clínico: paciente de 45 años de edad, blanca, femenina sin antecedentes mórbidos de salud, la cual presentó enrojecimiento del rostro y agotamiento de las extremidades al peinarse. Se le realiza tomografía axial computarizada donde se identificó una lesión sugestiva de trombosis, se decide su traslado hacia un centro especializado, se llega a la conclusión de que la paciente era portadora de una lesión tumoral no trombótica, la cual resultó ser benigna en una biopsia realizada por lo cual se decide seguimiento. La paciente reingresa en estado de shock cardiogénico por progresión de la enfermedad y se decide su tratamiento quirúrgico de emergencia, durante la cirugía fallece. Conclusiones: el leiomiosarcoma de la vena cava superior es una enfermedad rara, existen pocos reportes en la literatura sobre este padecimiento. Se presentó un caso en el cual el tumor se extendía de forma intraluminal a las cavidades cardíacas derechas (aurícula y ventrículo).

ABTRACT Background: the leiomyosarcoma of the superior cava vein is a rare illness and more when it extends to the cardiac cavities. Objective: to present to the medical community a female patient with leiomyosarcoma of the superior cava vein that extended intraluminal form to the right cavities of the heart causing obstruction and cardiogenic shock. Clinical case: a 45-year-old white female patient with no morbid health history, who presented redness of the face and exhaustion of the extremities when combing. A computerized axial tomography was performed where a lesion suggestive of thrombosis was identified. It was decided to transfer her to a specialized center, in which it is concluded that the patient was a carrier of a non-thrombotic tumor lesion, which turned out to be benign in a biopsy done for which follow-up is decided. The patient reenters in a state of cardiogenic shock due to progression of the disease, which is why her emergency surgical treatment is decided and die during surgery. Conclusions: the leiomyosarcoma of the superior vena cava is a rare illness, with few reports in the literature. A case in which the tumor extended intraluminally to the right cardiac cavities (atrium and ventricle) is presented.

Superior vena cava syndrome: endovascular management / Tratamento endovascular da síndrome da veia cava superior

The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms

O tratamento da síndrome da veia cava superior (SVCS) visa aliviar, rapidamente, os sintomas desconfortáveis. Os resultados das abordagens convencionais nem sempre são tão rápidos quanto os do tratamento endovascular com colocação de stent. Objetivos Relatar a experiência de um Serviço de Cirurgia Vascular e Endovascular de hospital universitário brasileiro com o tratamento endovascular da SVCS. Métodos Vinte e oito pacientes com SVCS sintomática tipo III foram tratados com angioplastia e colocação de stent, entre 2002 e 2012. A idade variou entre 37 e 68 anos. A SVCS resultou de doença neoplásica pulmonar ou torácica em 18 pacientes e de oclusão da veia por uso prolongado de cateteres em 10 pacientes. Resultados Não foi possível reparo da oclusão da veia em um paciente oligossintomático com lesão bastante grave. O sucesso técnico foi de 96,4%. Houve duas mortes, sendo uma por embolia pulmonar 24 horas após procedimento bem-sucedido e outra por compressão das vias aéreas por massa tumoral algumas horas após o procedimento. Houve sucesso clínico em todos os casos de sucesso técnico, incluindo o paciente que faleceu de repente após ter apresentado regressão total dos sintomas. Os sintomas desapareceram em 24 e 48 horas após o tratamento em, respectivamente, 16 e oito pacientes. A melhora foi mais lenta, embora progressiva, após 48 horas nos demais pacientes. Conclusões A colocação de stent endovascular no tratamento da SVCS foi eficaz, com boas taxas de sucesso técnico e clínico e alívio mais rápido dos sintomas

Successful stent implantation in a rural area on a patient with superior vena cava syndrome through specialist intervention: a case report / Journal of Rural Medicine

Superior vena cava syndrome (SVCS), which is characterized by facial edema and congestion of the head, upper extremities, and neck, is a life-threatening oncologic emergency. Although a combination of chemotherapy and radiation therapy has been considered as the standard treatment for SVCS, stent implantation to the superior vena cava (SVC) has been recently developed to alleviate edema or dyspnea caused by SVCS. On the other hand, stent implantation to the SVC requires skilled interventional cardiologists or radiologists. In general, those specialists reside in university hospitals or large hospitals in an urban area. In this case report, an 86-year-old man underwent stent implantation to a stenosed SVC in a rural area. Because the patient refused the transfer to the core, urban hospital, we invited a skilled interventional cardiologist from the core hospital and performed stent implantation to the SVC in a small, rural hospital. It is generally difficult to perform stent implantation for SVCS in a small hospital, because skilled operators in the field of interventional cardiology or radiology do not usually perform operations in smaller facilities. Our case indicates the importance of cooperation between rural generalists and urban specialists.

Clinical study of large fraction intensity modulated radiation therapy combined with apatinib in treatment of elderly non-small cell lung cancer patients with superior vena cava syndrome / 肿瘤研究与临床

Objective To observe the clinical efficacy of large fraction intensity modulated radiation therapy combined with apatinib in the treatment of elderly patients with non-small cell lung cancer and superior vena cava syndrome. Methods A retrospective analysis was made on 46 elderly patients with non-small cell lung cancer and superior vena cava syndrome who were admitted to Xuzhou Cancer Hospital Affiliated to Jiangsu University from February 2015 to December 2017. The patients were divided into observation group and control group with 23 cases in each group. The control group received radiation therapy only. Apatinib was enrolled in the observation group on the first day synchronously. The remission time of symptoms, short-term efficacy, occurrence of adverse reactions and 1-year overall survival rate were observed and compared between the two groups. Results The complete remission rate was 78.3％ (18/23) in the observation group and 43.3％ (10/23) in the control group, and the difference between the two groups was statistically significant (χ 2 = 4.60, P < 0.05). The effective response rate was 86.9％ (21/23) in the observation group and 65.2％ (15/23) in the control group, and the difference between the two groups was statistically significant (χ 2 = 4.294, P < 0.05). The main adverse reactions in the two groups were radioactive esophagitis, radiation pneumonitis and leukopenia, and most of them were grade Ⅰ-Ⅱ, there was no significant difference between the two groups (all P > 0.05). The 1-year overall survival rate was 56％ in the observation group and 40％ in the control group, and the difference between the two groups was statistically significant (P = 0.009). Conclusion Large fraction intensity modulated radiation therapy combined with apatinib is effective in the treatment of elderly patients with non-small cell lung cancer and superior vena cava syndrome, and theadverse reactions are well tolerated.

Síndrome de la vena cava superior: diagnóstico y tratamiento / Superior vena cava syndrome: Diagnosis and treatment

Resumen: El síndrome de la vena cava superior es un conjunto de signos y síntomas desencadenados por la obstrucción de la vena cava superior. Los tumores intratorácicos malignos son la principal causa. Sin embargo, en las últimas décadas se han descrito causas benignas, como la trombosis asociada con la colocación de accesos venosos.

Abstract: Superior vena cava syndrome is a set of signs and symptoms due to superior vena cava obstruction. Intratoracic malignant tumors are the main cause. However, in last decades benign causes such as thrombosis related to venous access colocation have been described.

Síndrome de la vena cava superior por adenocarcinoma de pulmón a forma mediastinal / Superior vena cava syndrome due to lung adenocarcinoma on the mediastinal way

La primera descripción realizada del síndrome de la vena cava superior (SVCS) la realizó William Hunter en 1757, en un paciente con aneurisma sifilítico de aorta. Actualmente con el desarrollo de los tratamientos antimicrobianos estas enfermedades son raras y se deben en un gran porcentaje a patologías malignas. Las neoplasias malignas dan lugar al 90 por ciento de los casos de SVCS y son en su mayoría carcinomas de pulmón. Menos comúnmente el SVCS maligno está producido por linfomas, metástasis y tumores intratorácicos como mesoteliomas o timomas. El objetivo es presentar una forma poco habitual del síndrome de la vena cava superior ocasionada por una neoplasia de pulmón cuya variante histológica, el adenocarcinoma, no suele producir esta forma de presentación radiológica. Se presenta una paciente femenina de 48 años de edad, fumadora, operada de neumotórax izquierdo, que acude a consulta refiriendo la aparición de dolor y aumento de volumen localizado en el cuello, hombro y miembro superior derecho de 3 meses de evolución, de moderada intensidad, permanente, asociado con la presencia de impotencia funcional y edema del miembro superior. En consultas previas se le diagnosticó bursitis y se prescribió tratamiento antiinflamatorio y fisioterapia empeorando la sintomatología, decidiéndose la realización de ultrasonido del hombro derecho. Clásicamente se describe que el adenocarcinoma se manifiesta radiológicamente como un nódulo o una masa pulmonar solitaria, periférica, lo cual difiere con nuestro caso cuya forma de presentación es un síndrome de la vena cava superior siendo una forma poco habitual en este tipo histológico(AU)

The first description of superior vena cava syndrome (SVCS) was made by William Hunter in 1757, in a patient with syphilitic aortic aneurysm. Currently, with the development of antimicrobial treatments, these diseases are rare and largely due to malignant pathologies. Malignant neoplasms account for 90 percent of cases of SVCS and are mostly lung carcinomas. Less commonly, malignant SVCS is produced by lymphomas, metastases and intrathoracic tumors, such as mesotheliomas or thymomas. The aim of the study is to present an unusual form of the SVCS caused by a lung neoplasm whose histological variant, adenocarcinoma, does not usually produce this form of radiological presentation. We present a patient aged 48, smoker, operated for left pneumothorax, who comes to office referring the onset of pain and increased volume located in the neck, shoulder and right upper limb of 3 months of evolution, of mild intensity, permanent, associated with the presence of functional impotence and edema of the upper limb. In previous consultations, he was diagnosed with bursitis and anti-inflammatory and physiotherapy treatment was prescribed, the symptoms worsened, while ultrasound of the right shoulder was decided. Classically, adenocarcinoma is described as radiologically manifested as a solitary, peripheral nodule or lung mass, which differs with our case, whose presentation is a superior vena cava syndrome being an unusual form in this histological type(AU)

Huge Syphilitic Aneurysm of the Thoracic Aorta Complicated with Airway Obstruction and Superior Vena Cava Syndrome / 日本心臓血管外科学会雑誌

Today, syphilitic aortic aneurysm is rarely diagnosed due to widespread use of penicillin for early syphilis. Large aneurysms can be symptomatic by compressing on adjacent organs. We report a case of a huge syphilitic aneurysm of the thoracic aorta complicated with airway obstruction and superior vena cava syndrome. A 62-year-old man presented with acute severe dyspnea and distention of superficial veins. Contrast-enhanced computed tomography revealed an aneurysm of the ascending aorta extending to the transverse arch the diameter of which was 90 mm. The aneurysm compressed the bilateral main bronchi and superior vena cava. We performed an emergency operation because respiratory failure persisted despite the support of a ventilator. Since the aneurysm eroded the sternum, median sternotomy was performed under hypothermic circulatory arrest. Dissecting the aneurysm was complicated due to dense adhesion. Ascending aorta and partial arch replacement with reconstruction of the brachiocephalic trunk was successfully performed with antegrade cerebral perfusion. Postoperative computed tomography demonstrated that compression of the bilateral main bronchi was released. The result of preoperative syphilitic serologic test was strongly positive, and pathological findings of the aneurysm wall specimen was compatible with syphilitic aneurysm. Following treatment with benzyl penicillin for 14 days, the patient was discharged on the 19th postoperative day without specific complications.

The Unspoken Presentation Of The Uncommon: Superior Vena Cava Syndrome

Superior vena cava syndrome is a medical emergency. The morbidity and mortality of superior vena cava syndrome can be decreased by early recognition, early establishment of primary cause, early supportive and definitive treatment. We illustrate a case of 53-year-old male with underlying advanced Parkinsonism and ischemic stroke who presented with superior vena cava syndrome over 4 days period. Diagnostic challenge in this patient lies in the fact that patient had aphasia and his daily living activity was dependent. Most of the information was based on caretaker’s observations. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment of superior vena cava syndrome.

Coma mixedematoso e trombo de veia cava superior. Relato de caso e revisão da literatura / Myxedema coma and superior vena cava thrombus: case report and literature review

O coma mixedematoso é uma emergência endocrinológica rara e consiste na máxima expressão do hipotireoidismo, com alta mortalidade por suas complicações hemodinâmicas e ventilatórias, podendo ser agravadas por distúrbios da coagulação. Relatamos o caso de uma paciente diagnosticada com coma mixedematoso e trombo de veia cava superior. Buscamos salientar os distúrbios de coagulação frequentes no hipotireoidismo grave, que contribuem para o aumento da mortalidade deste grupo de pacientes. O diagnóstico e o tratamento precoce do coma mixedematoso, aliados à instituição imediata da terapia para o fenômeno trombótico encontrado, permitiram a evolução favorável do quadro. O relato, juntamente da bibliografia pesquisada, orientou o raciocínio sobre a relação dos distúrbios de coagulação, que ocorrem no hipotireoidismo descompensado. Apesar de poucos relatos, estes distúrbios podem ser frequentes e devem ser pesquisados, pois contribuem com o aumento da mortalidade.(AU)

Myxedema coma is a rare endocrinological emergency, consisting of the highest expression of hypothyroidism with high mortality due to hemodynamic and ventilatory complications, which may be aggravated by coagulation disorders. We report the case of a patient diagnosed with myxedema coma and superior vena cava thrombus. We sought to emphasize the frequent coagulation disorders in severe hypothyroidism, which contribute to increased mortality in this group of patients. The diagnosis and early treatment of myxedema coma, together with the immediate institution of therapy for the thrombotic phenomenon found, allowed the favorable evolution of the condition. The report, together with the literature, has guided the rationale for the influence of coagulation disorders that occur in decompensated hypothyroidism. Despite the few number of reports, these disorders can be frequent and should be investigated because they contribute to the increase in mortality.(AU)