Superior vena cava syndrome: an oncologic complication

An unusual clinical presentation resembling superior vena cava syndrome post heart surgery

Background

An unusual sequence of post operative events heralded by hemodynamic deterioration followed by dyspnea and rapidly progressive dilatation of superficial neck and facial veins, resembling a superior vena cava syndrome, two days post surgical resection of filamentous aortic valve masses, closure of a patent foramen ovale, and performance of a modified Maze procedure for atrial fibrillation in a patient that presented with transient neurologic findings is presented.

Case Presentation

Although both clinical findings and hemodynamic derangements completely resolved following tricuspid valve repair aimed to correct the new onset severe tricuspid regurgitation noted post operatively; a clear mechanism was not readily obvious and diagnostic testing data somewhat conflictive. We present a careful retrospective examination of all clinical data and review possible clinical entities that could have been implicated in this particular case and recognize that transesophageal echocardiographic findings were most useful in identifying the best course of action.

Conclusion

After reviewing all clinical data and despite the inconclusive nature of test results; the retrospective examination of transesophageal echocardiographic findings proved to be most useful in identifying the best course of action. We postulate that in our case, resolution of the suspected pulmonary embolism with anticoagulation and reestablishment of a normal right ventricular geometry with tricuspid valve repair worked in unison in restoring normal hemodynamics and resolving both dyspnea and venous dilatation.

Nonmalignant superior vena cava syndrome: Pathophysiology and management

Superior vena cava (SVC) syndrome occurs following obstruction either from external compression or internal thrombosis or scarring. In the past, treatment was limited to medical therapy or surgical bypass but now percutaneous revascularization presents a viable therapeutic option. We present our experience in the percutaneous therapy of patients with nonmalignant SVC syndrome and review the condition with regard to its pathophysiology and management.

[Superior vena cava syndrome caused by multinodular goiter]

Currently, the vena cava superior syndrome (VCSS) is mainly of oncologic origin. We report here four cases of this syndrome caused by intrathoracic multinodular goiter. All patients had compressive symptoms, particularly of the oesophagus and trachea. Axial CT was the imaging technique that delineated the intrathoracic multinodular goiter compressing brachiocephalic vessels. Surgery (total thyroidectomy) was used and all compressive symptoms resolved.

Superior vena cava stenting

Treatment of SVC obstruction with metallic stents is a rewarding procedure. The patients have symptoms that are severe and debilitating and cause significant impairment of life-style. Stent placement rapidly alleviates the symptoms of SVC syndrome and improves the patient's quality of life. The long-term patency rates have not been established; however, in patients with SVC syndrome secondary to malignant disease, stents usually remain patent for the lifetime of the patient. Recurrences can be treated with further interventional radiographic techniques. Currently, because the long-term patency rates of SVC stents are not known, most interventional radiologists tend to treat SVC stenosis from benign causes with balloon angioplasty before placing metallic stents.

Superior vena cava syndrome

OBJECTIVES

To provide a review of the treatment and nursing management of superior vena cava syndrome (SVCS).

DATA SOURCES

Review articles, research studies, and book chapters.

CONCLUSIONS

SVCS is primarily associated with small cell lung cancer. It usually has a chronic, insidious onset, but may present acutely with laryngeal or cerebral edema. Radiotherapy, chemotherapy, surgery, thrombolysis, and interventional radiology have provided effective treatment.

IMPLICATIONS FOR NURSING PRACTICE

Management of the patient with SVCS includes recognition of high-risk patients and initial symptomatology, accurate assessments, appropriate therapies, psychosocial support, and education regarding recurrent SVCS.

Metastases that interfere with circulation

OBJECTIVES

To review the nursing implications of select circulatory problems caused by metastatic cancer.

DATA SOURCES

Journal articles, research studies, and book chapters relating to circulatory problems associated with metastatic disease.

CONCLUSIONS

During the metastatic process, tumor cells can interfere with circulation. As a result, circulatory impairments can range from life threatening to manifestations that may alter a person's quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses have a responsibility to seek current knowledge about therapeutic and supportive care for persons experiencing circulatory alterations. Collaboration with colleagues can facilitate patient care in these clinical situations. Patient education can be supportive and may enhance optimal outcomes.