ABSTRACT
Approximately 15,000 cases of superior vena cava (SVC) obstruction are diagnosed in the United States annually. Malignancies (primarily lung cancer) are the underlying cause of 80-85% of cases, leaving 15-20% caused by various benign conditions, including sclerosing mediastinitis (the diagnosis in our case). Thrombolytic therapy and major advances in vascular techniques in recent years have improved the outcome and lessened the morbidity of SVC obstruction. However, even though a benign condition, sclerosing mediastitinis is a dynamic, ongoing fibrotic condition that seldom can be totally removed surgically. It frequently causes recurrent episodes of SVC obstruction, requiring further repetitive vascular procedures that can result in major morbidity and even mortality.
Subject(s)
Insurance, Life , Superior Vena Cava Syndrome/surgery , Chest Pain/diagnosis , Chest Pain/physiopathology , Humans , Male , Mediastinitis/complications , Mediastinitis/therapy , Middle Aged , Prognosis , Superior Vena Cava Syndrome/economics , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/mortality , Superior Vena Cava Syndrome/physiopathologyABSTRACT
Venous thrombosis and subsequent obstruction of the superior vena cava may be life threatening and therefore warrant immediate attention. This case report represents the successful treatment of superior vena cava thrombosis with urokinase in a patient with an indwelling Hickman catheter. Patency of the occluded vessel and resolution of clinical symptoms were achieved within 24 hours of initiation of a 12-hour urokinase infusion.
