Abordaje quirúrgico del síndrome de vena cava superior asociado a neoplasia maligna: revisión narrativa / Surgical approach to superior vena cava syndrome associated with malignant neoplasm: A narrative review

Introducción: El síndrome de vena cava superior (SVCS) es una patología poco frecuente, asociado en la mayoría de los casos a neoplasias de origen maligno; la cual en estadios avanzados representa una urgencia médico-oncológica que compromete la vida del paciente. Propósito de la revisión: El objetivo de la revisión es delinear el rol de las diferentes alternativas quirúrgicas y percutáneas para el tratamiento del SVCS. Buscamos reportes en donde se incluye los resultados de mejor supervivencia para los distintos tratamientos actuales. Recientes hallazgos: La literatura médica describe tratamientos como la radioterapia, la quimioterapia, el bypass, la terapia endovascular y la reconstrucción vascular para el manejo del SVCS, sin embargo, no todos responden con la misma eficacia al momento de presentarse una urgencia vital por SVCS; esto producto de los factores intrínsecos y extrínsecos del paciente. Dentro de los factores extrínsecos destaca la condición social la cual, se convierte en un reto al momento de realizar un manejo integral del paciente en ciudades fronterizas, donde los datos que conoce el médico sobre el paciente son limitados o el paciente no tiene un diagnóstico previo que permita orientar el manejo. Conclusiones: El punto de partida del tratamiento del paciente con SVCS consiste en diferenciar la emergencia y la estabilidad mediante la tabla de clasificación de gravedad. En casos emergentes se tiene 2 alternativas: la terapia endovascular y la radioterapia. El abordaje quirúrgico con Baypass está contraindicado y el tratamiento definitivo con reconstrucción vascular con prótesis tiene ventajas y desventajas que deben definirse en forma individual considerando la etiología del cáncer asociado.

Introduction: Superior vena cava syndrome (SVCS) is a rare pathology, associated in most cases with neoplasms of malignant origin; which in advanced stages represents a medical-oncological emergency that compromises the patient's life. Purpose of the review: The objective of the review is to outline the role of the different surgi-cal and percutaneous alternatives for the treatment of SVCS. We look for reports that include the best survival results for the different current treatments. Recent findings: The medical literature describes treatments such as radiotherapy, chemo-therapy, bypass, endovascular therapy and vascular reconstruction for the management of SVCS, however, not all respond with the same efficacy at the time of a vital emergency. by SVCS; this product of the intrinsic and extrinsic factors of the patient. Among the extrinsic fac-tors, the social condition stands out, which becomes a challenge when carrying out an integral management of the patient in border cities, where the data that the doctor knows about the patient is limited or the patient does not have a previous diagnosis. to guide management. Conclusions: The starting point of the treatment of the patient with SVCS consists in differentiating the emergency and the stability by means of the severity classification table. In emergent cases there are 2 alternatives: endovascular therapy and radiotherapy. The surgical approach with Baypass is contraindicated and the definitive treatment with vascular reconstruc-tion with a prosthesis has advantages and disadvantages that must be defined individually considering the etiology of the associated cancer.

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)

Generalidades de las principales urgencias en el paciente oncológico: revisión de tema / Overview of the main emergencies in cancer patients: Review / Generalidades das principais urgências no paciente oncológico: revisão de tema

Las urgencias oncológicas son complicaciones comunes de la evolución natural del tumor o de su manejo. Algunas pueden presentarse de manera sutil y ser pasadas por alto, lo que aumenta la morbimortalidad. El objetivo de esta revisión narrativa es recopilar información actualizada de las principales complicaciones oncológicas, para ello se realizó una revisión de artículos originales, revisiones sistemáticas y narrativas en bases de datos como Scopus, SciELO, PubMed, ScienceDirect y en el buscador Google Scholar. Se seleccionaron 63 referencias que mostraran información relevante acerca de las urgencias oncológicas planteadas para el desarrollo del artículo. En la revisión se discute que las complicaciones pueden clasificarse de acuerdo con su origen en infecciosas (neutropenia febril), metabólicas (síndrome de lisis tumoral e hipercalcemia maligna) y obstructivas (síndrome de vena cava superior, obstrucción intestinal, compresión medular y taponamiento cardiaco). El diagnóstico requiere un alto índice de sospecha, el médico debe tener la capacidad resolutiva y el conocimiento necesarios para el manejo y hacer uso racional de los recursos diagnósticos. Es necesario adoptar medidas terapéuticas que impacten positivamente en el pronóstico y que reduzcan la morbimortalidad.

Oncological emergencies are common complications resulting from the natural evolution of the tumor or its management; however, some of them may be subtle or even overlooked, which contributes to greater morbidity and mortality. Our aim was to gather updated information on the main oncological complications. A narrative literatura review was performed by searching for original articles, systematic reviews and narratives, in databases such as Scopus, SciELO, PubMed, ScienceDirect and in the Google Scholar search engine. 63 references were selected that addressed relevant information about the oncological emergencies raised for the development of the article. According to their origin, complications can be classified into infectious (febrile neutropenia), metabolic (tumor lysis syndrome and malignant hypercalcemia) and obstructive (superior vena cava syndrome, intestinal obstruction, spinal cord compression and cardiac tamponade). Facing these complications requires a high level of suspicion; the physician must be able to resolve each complication and have the necessary knowledge to approach each case, with a rational use of diagnostic resources. It is also necessary to adopt therapeutic measures that positively impact patients. patient prognosis, decreasing morbidity and death.

As urgências oncológicas são complicações comuns da evolução natural do tumor ou do seu manejo. Algumas podem apresentar-se de maneira sutil e ser passadaspor encima, o que aumenta a morbimortalidade. O objetivo desta revisão narrativa é recopilar informação atualizada das principais complicações oncológicas, para isso se realizou uma revisão de artigos originais, revisões sistemáticas e narrativas em bases de dados como Scopus, SciELO, PubMed, ScienceDirect e no buscador Google Scholar. Se selecionaram 63 referências que mostraram informação relevante sobre às urgências oncológicas apresentadas para o desenvolvimento do artigo. Na revisão se discuteque as complicações podem classificar-se de acordo com a sua origem em infecciosas (neutropenia febril), metabólicas (síndrome de lise tumoral e hipercalcemia maligna) e obstrutivas (síndrome de veia cava superior, obstrução intestinal, compressão medular e entupimento cardíaco). O diagnóstico requere um alto índice de suspeita, o médico deve ter a capacidade resolutiva e o conhecimento necessário para o manejo e fazer uso racional dos recursos diagnósticos. É necessário adotar medidas terapêuticas que impactem positivamente no prognóstico e que reduzam a morbimortalidade.

Urgencias en cuidado paliativo oncológico / Emergencies in palliative oncological care

El paciente oncológico de cuidados paliativos puede presentar una variedad importante de condiciones clínicas que producen sufrimiento y disminución en la calidad de vida; esto se presenta como un reto para el clínico en la identificación y correcto abordaje de los pacientes. El dolor se ha considerado por años como el síntoma cardinal a tratar en el paciente oncológico, donde se deben considerar sus condicionantes fisiopatológicos, la farmacología de las intervenciones, los posibles efectos secundarios y los condicionantes familiares, sociales y personales del dolor, pero a pesar de su relevancia, no es el único síntoma, estando acompañado de un abanico de patologías, como las afectaciones gastrointestinales, pulmonares, vasculares, hematológicas y neurológicas, que favorecen la pérdida de capacidad del paciente y, en muchas ocasiones, la muerte. Se realizó una revisión actualizada en bases de datos como EMBASE, PUBMED, SCIELO, además de la revisión de guías de asociaciones internacionales con el objetivo de acercar a todos los médicos, sin distinguir su especialidad o área de trabajo, al abordaje y manejo del paciente oncológico en cuidado paliativo, favoreciendo la sensibilización con estas patologías y la importancia en el curso de vida de los pacientes.

The palliative care cancer patient can present a significant variety of clinical conditions that produce suffering and a decrease in the quality of life. This is a challenge for the clinician in the identification and correct approach of patients. Pain has been considered for years as the cardinal symptom to be treated in cancer patients, where its pathophysiological factors, the pharmacology of the interventions, possible side effects and the family, social and personal conditions of pain must be considered, but despite its relevance is not the onset of symptoms and is accompanied by a range of pathologies such as gastrointestinal, pulmonary, vascular, hematological and neurological affectations that favor the loss of capacity of the patient and in many cases death. An updated review was carried out in databases such as EMBASE, PUBMED, SCIELO in addition to the revision of guides from international associations with the aim of bringing all doctors without distinguishing their specialty or area of work to the approach and management of cancer patients in palliative care favoring awareness of these pathologies and their importance in the life course of patients.

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report / Ruptura contida de um aneurisma do arco aórtico em paciente com aortite sifilítica. Um relato de caso

Abstract Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.

Resumo A aortite sifilítica é uma complicação rara da sífilis terciária, que pode levar a formação de aneurisma aórtico, insuficiência valvar aórtica e estenose ostial coronariana. Ao longo das últimas décadas, a sífilis ressurgiu ao redor do mundo, e os cirurgiões vasculares devem estar atentos às suas manifestações cardiovasculares. Apresentações clínicas atípicas, como a hemoptise, e um padrão na angiotomografia computadorizada de parede aneurismática mais grossa com projeções de aneurisma com aparência de úlcera devem levantar a suspeita de aneurisma sifilítico da aorta. O diagnóstico precoce e terapias cirúrgica e clínica adequadas contribuem significativamente para um tratamento bem-sucedido e prognóstico favorável. Relatamos o caso de um paciente do sexo masculino, de 82 anos, que apresentou infecção por sífilis com ruptura iminente de aneurisma do arco aórtico. Ele foi tratado com reparo híbrido do arco. Após 7 meses, o paciente deu entrada na emergência com parada cardiorrespiratória. As manobras de reanimação cardiopulmonar foram realizadas, mas não obtiveram sucesso, e a autópsia mostrou tamponamento cardíaco devido à ruptura da aorta ascendente.

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

The largest reported giant ascending aortic aneurysm presented with superior vena cava syndrome

Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.

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

The bridge occlusion balloon for venous angioplasty in superior vena cava occlusion

Abstract The Bridge Occlusion Balloon is a compliant balloon, specifically designed for temporary Superior vena cava occlusion in case of Superior Vena Cava laceration during lead extraction procedures. We here report the first case, using Bridge Occlusion Ballon for a venous angioplasty in a patient with dysfunctional pacemaker leads and symptomatic Superior Vena Cava occlusion. After successful lead extraction, venography was showing a narrow venous canal. Therefore, venous angioplasty using the Bridge balloon was performed. Especially for high-risk lead extraction cases in patients with Superior Vena Cava stenosis, the Bridge Occlusion Ballon might be used as a combination of a safety-net in case of Superior Vena Cava perforation and for Superior Vena Cava angioplasty.

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

Upper vena cava syndrome secondary to giant atrial myxoma

SUMMARY Cardiac myxoma is a benign neoplasm, which corresponds to the most common primary heart tumour, responsible for about 50% of the cases. In general, 75-80% of myxomas are located in the left atrium, 18% in the right atrium, and more rarely in the ventricles or multicentric. Right atrial myxoma, in particular, can obstruct the tricuspid valve, causing symptoms of right heart failure, peripheral oedema, hepatic congestion, and syncope. Systemic embolization occurs in 30% of cases, by either tumour fragmentation or total tumour detachment. In the present report, we present a case of a symptomatic patient, who showed a large right intra-atrial lesion, with consequent superior vena cava syndrome, and then underwent surgical resection at admission.

RESUMO O mixoma cardíaco é uma neoplasia benigna, que corresponde ao tumor primário mais comum do coração, responsável por cerca de 50% dos casos. De modo geral, 75 a 80% dos mixomas estão localizados no átrio esquerdo, 18% no átrio direito, e mais raramente, nos ventrículos ou multicêntricos. O mixoma atrial direito, em particular, pode obstruir a válvula tricúspide, causando sintomas de insuficiência cardíaca direita, edema periférico, congestão hepática e síncope. A embolização sistêmica ocorre em 30% dos casos, quer pela fragmentação do tumor ou pelo desprendimento total do mesmo. No presente relato, apresentamos um caso de uma paciente sintomática, que evidenciou grande lesão intra-atrial direita, com consequente síndrome da veia cava superior, sendo, então, submetida a ressecção cirúrgica na internação.

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)

Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery: A case report

Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomy-Trendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.

Surgical Treatment of Malignant Thymoma Invading the Superior Vena Cava / 中国肺癌杂志

This paper introduced surgical treatment of malignancy-related superior vena cava syndrome. Typical cases were presented with diagnostic radiology results. Authors focused on the main approach to the malignancy-related superior vena cava syndrome of surgery. In order to make it simple for junior doctors to learn and practice, all 4 operation methods were described in details. The writer hopes it would be helpful for all the young thoracic surgeons.
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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)