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Tennigkeit J, Teich T, Lübcke J, Schreyer AG, Ritter O. Flowreversal in the left internal jugular vein due to a prominent brachiocephalic trunk: A case report. Radiol Case Rep 2024; 19:3004-3007. [PMID: 38737176 PMCID: PMC11087902 DOI: 10.1016/j.radcr.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or external compression from a tumor. We describe a rare case of chronic headache and hearing loss due to flow reversal in the left internal jugular vein and compensatory massive dilation of the right internal jugular vein. Flow reversal was caused by a prominent brachiocephalic trunk with subseqent compression of the vena brachiocephalica sinistra. Vascular anomalies and associated venous bypass circulation may be considered as a rare cause of non-specific malaise. Restoration of the physiological direction of blood flow should be discussed on an interdisciplinary basis given the unpredictable haemodynamic consequences.
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Affiliation(s)
- Johanna Tennigkeit
- Department of Cardiology, Nephrology and Pneumology, Brandenburg Medical School, Theodor Fontane, University Hospital Brandenburg/Havel, Hochstraße 29 14770, Brandenburg/Havel, Germany
| | - Thomas Teich
- Department for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Hochstraße 29 14770, Brandenburg/Havel, Germany
| | - Jonas Lübcke
- Department of Cardiology, Nephrology and Pneumology, Brandenburg Medical School, Theodor Fontane, University Hospital Brandenburg/Havel, Hochstraße 29 14770, Brandenburg/Havel, Germany
| | - Andreas G. Schreyer
- Department for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Hochstraße 29 14770, Brandenburg/Havel, Germany
| | - Oliver Ritter
- Department of Cardiology, Nephrology and Pneumology, Brandenburg Medical School, Theodor Fontane, University Hospital Brandenburg/Havel, Hochstraße 29 14770, Brandenburg/Havel, Germany
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3
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Byun E, Mayeda GS. Intravascular ultrasound diagnosis of a venous obstruction not visualized by conventional venography: a case report. Catheter Cardiovasc Interv 2002; 57:61-4. [PMID: 12203930 DOI: 10.1002/ccd.10278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Eugene Byun
- Harbor-UCLA Medical Center, Torrance, California 90017, USA
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4
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Fernandez B, Smolley LA, Swirsky SM, Kaye MD. Relief of sleep apnea after intravascular stenting for superior vena cava syndrome. Vasc Med 2001; 4:33-6. [PMID: 10355868 DOI: 10.1177/1358836x9900400106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rarely reported association of sleep apnea and superior vena cava stenosis from mediastinal fibrosis is described. A case is presented where substantial improvement in the sleep parameters and the symptoms of sleep apnea occurred subsequent to superior vena cava thrombolysis and stent angioplasty.
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Affiliation(s)
- B Fernandez
- Department of Vascular Medicine, Cleveland Clinic Florida, Ft. Lauderdale 33309, USA
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5
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Abstract
Lung cancer is the most common cause of superior vena cava syndrome (SVCS) and requires timely recognition and management. The syndrome is rarely an oncologic emergency in the absence of tracheal compression and airway compromise. Treatment depends on the etiology of the obstructive process. Treatment should also be individualized and should not be undertaken until a diagnosis is obtained. Most patients with SVCS secondary to lung cancer can be treated with appropriately directed chemotherapy or radiotherapy. With the refinement of endovascular stents, percutaneous stenting of the SVC is being increasingly used as primary treatment modality. Thrombotic occlusion can be treated with appropriate lytic agents. In rare circumstances, surgical decompression can be performed; bypass or replacement of the SVC results in immediate improvement in the majority of cases and can be accomplished with low morbidity.
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Affiliation(s)
- L J Wudel
- Vanderbilt University Medical Center and St. Thomas Hospital, 4230 Harding Road, Nashville, TN 37205, USA
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6
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Hayashi Y, Ohtake S, Sawa Y, Imagawa H, Hirata N, Matsuda H. [Painless aortic dissection late after aortic valve replacement, presenting as superior vena cava syndrome]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:724-9. [PMID: 9785870 DOI: 10.1007/bf03217809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 68-year-old man, who had underwent aortic valve replacement (AVR) with Björk-Shiley disc valve for aortic regurgitation 17 years ago, was transferred to our hospital complaining of facial redness and swelling, without chest or back pain. Preoperative examination revealed DeBakey type II aortic dissection, which caused superior vena cava syndrome (SVC syndrome). Emergent ascending aortic replacement was performed, postoperatively central venous pressure (CVP) decreased from 33 to 9 mmHg, and SVC syndrome was relieved. Painless aortic dissection after AVR, presenting as SVC syndrome, is a rare case, and close follow-up should be performed under consideration of painless aortic dissection late after AVR.
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Affiliation(s)
- Y Hayashi
- First Department of Surgery, Osaka University Medical School, Japan
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7
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Patel PC, Millman B, Pellitteri PK, Woods EL. Papillary Thyroid Carcinoma Presenting with Massive Angioinvasion of the Great Vessels of the Neck and Chest. Otolaryngol Head Neck Surg 1997. [DOI: 10.1016/s0194-59989770076-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pranay C. Patel
- Danville, Pennsylvania
- Departments of Otolaryngology/Head & Neck Surgery, Geisinger Medical Center
| | - Brad Millman
- Danville, Pennsylvania
- Departments of Otolaryngology/Head & Neck Surgery, Geisinger Medical Center
| | - Phillip K. Pellitteri
- Danville, Pennsylvania
- Departments of Otolaryngology/Head & Neck Surgery, Geisinger Medical Center
| | - Edward L. Woods
- Danville, Pennsylvania
- Cardiovascular & Thoracic Surgery, Geisinger Medical Center
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8
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McFarland JJ, Kahn MB, Bellows CF, Shah RM, Koenigsberg RA, Parsons RE, Whitman GJ, DiSesa VJ. Superior vena cava syndrome caused by aneurysm of the innominate artery. Ann Thorac Surg 1995; 59:227-9. [PMID: 7818334 DOI: 10.1016/0003-4975(94)00349-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Isolated aneurysms or ruptures of the innominate artery are rare causes of the superior vena cava syndrome. We report on a patient who suffered an isolated acute expansion and rupture of an innominate artery aneurysm that precipitated a dramatic superior vena cava syndrome. Immediate repair using modern surgical techniques, cardiopulmonary bypass, profound hypothermia, circulatory arrest, and a Dacron graft rapidly cured the patient of this deadly syndrome.
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Affiliation(s)
- J J McFarland
- Division of Cardiothoracic Surgery, Medical College of Pennsylvania, Philadelphia 19129
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9
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Rosenzweig BP, Kronzon I. Transesophageal echocardiographic diagnosis of the superior vena cava syndrome resulting from aortic dissection: a multiplane study. J Am Soc Echocardiogr 1994; 7:414-8. [PMID: 7917352 DOI: 10.1016/s0894-7317(14)80202-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The case of an 82-year-old patient with signs and symptoms of superior vena cava syndrome is described. A multiplane transesophageal echocardiogram demonstrated anatomic and Doppler flow evidence of superior vena caval obstruction due to compression by a dissected, aneurysmal ascending aorta. Multiplane transesophageal echocardiography is particularly useful in the diagnosis of superior vena cava syndrome when it is a sequela of thoracic aortic disease.
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Affiliation(s)
- B P Rosenzweig
- Department of Medicine, New York University Medical Center, NY
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10
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Dodds GA, Harrison JK, O'Laughlin MP, Wilson JS, Kisslo KB, Bashore TM. Relief of superior vena cava syndrome due to fibrosing mediastinitis using the Palmaz stent. Chest 1994; 106:315-8. [PMID: 8020305 DOI: 10.1378/chest.106.1.315] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Relief of superior vena cava (SVC) syndrome due to non-neoplastic mediastinal disease presents a formidable challenge. Long-term patency of surgically created bypass grafts has been poor, and the morbidity associated with these procedures is substantial. We report a case of SVC syndrome, caused by fibrosing mediastinitis, treated with Palmaz balloon expandable intravascular stents. Intravascular stents are a promising alternative for relief of non-neoplastic SVC obstruction.
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Affiliation(s)
- G A Dodds
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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Abstract
Aortic dissection usually presents with chest pain, abnormal pulses, and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome (SVCS), which more commonly occurs in the setting of malignant disease. A patient who had SVCS as a result of a painless aortic dissection is presented and compared with other previously reported cases of simultaneous SVCS and aortic dissection.
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Affiliation(s)
- M S Link
- Department of Internal Medicine, Malcolm Grow Medical Center, Andrews Air Force Base, MD 20331-6600
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12
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Giannoccaro PJ, Marquis JF, Chan KL, Walley V, Chambers RJ. Aortic dissection presenting as upper airway obstruction. Chest 1991; 99:256-8. [PMID: 1984971 DOI: 10.1378/chest.99.1.256] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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13
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Affiliation(s)
- A Wurtz
- Clinique Chirurgicale Ouest, Hôpital Claude Huriez, Lille, France
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Affiliation(s)
- K A Eagle
- Harvard Medical School, Massachusetts General Hospital, Boston
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15
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Affiliation(s)
- J W Yedlicka
- Department of Radiology, University of Minnesota, Minneapolis
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16
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-1987. A 60-year-old man with facial swelling, cyanosis, and dilatation of the ascending aorta. N Engl J Med 1987; 317:99-108. [PMID: 3587330 DOI: 10.1056/nejm198707093170207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Nieto AF, Doty DB. Superior vena cava obstruction: clinical syndrome, etiology, and treatment. Curr Probl Cancer 1986; 10:441-84. [PMID: 3757550 DOI: 10.1016/s0147-0272(86)80006-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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18
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Panos M, Braverman A. Superior Vena Cava Obstruction due to Ascending Aortic Aneurysm. Phlebology 1986. [DOI: 10.1177/026835558600100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M.Z. Panos
- St. Stephens Hospital, Fulham Road, London SW10 9TH
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19
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Kahn SE, Kotler MN, Goldman AP, Ablaza S. Superior vena caval obstruction secondary to acute dissecting aneurysm of the aorta. Am Heart J 1986; 111:606-8. [PMID: 3953376 DOI: 10.1016/0002-8703(86)90076-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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20
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Schofield PM, Bray CL, Brooks N. Dissecting aneurysm of the thoracic aorta presenting as right atrial obstruction. Heart 1986; 55:302-4. [PMID: 3954913 PMCID: PMC1232170 DOI: 10.1136/hrt.55.3.302] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A patient with a dissecting thoracic aortic aneurysm presented with acute low output cardiac failure due to right atrial obstruction. Five years earlier she had had her aortic valve replaced because of aortic regurgitation. Obstruction of the superior vena cava and pulmonary artery has been reported elsewhere as a complication of compression by thoracic aortic dissecting aneurysm. This case was unusual in presenting as right atrial obstruction.
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22
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Glanz S, Gordon DH, Shah N, Jaffe B, Griepp R. Unusual manifestations of aortic dissection. Cardiovasc Intervent Radiol 1982; 5:292-5. [PMID: 7168833 DOI: 10.1007/bf02552800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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23
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Abstract
In a 65 year old man with hemoptysis, chest pain, weight loss, clubbing of the digits and a large mediastinal mass, the superior vena cava syndrome developed. He was treated for malignancy with radiation therapy and corticosteroids, but he died shortly after his admission to the hospital. Autopsy revealed syphilitic aortitis with an aneurysm of the ascending aorta compressing the superior vena cava and right mainstem bronchus. The postmortem serology corroborated the morphologic findings of tertiary syphilis. In this report we emphasize the important, although now uncommon, association between the superior vena cava syndrome and aneurysm of the aorta.
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24
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Saw HS, Yar SN, Sivanesan S. Aneurysm of the right subclavian artery: an unusual cause of superior vena caval obstruction. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1979; 49:241-3. [PMID: 288453 DOI: 10.1111/j.1445-2197.1979.tb04947.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A case of superior vena caval (SVC) obstruction caused by an aneurysm of the right subclavian artery is presented. Malignant conditions are the commonest aetiological factors in SVC obstruction, but benign and potentially treatable lesions account for an important minority. The importance of attempting to establish a fully documented diagnosis, including histological proof, in all patients presenting with this syndrome is emphasized.
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25
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Nogeire C, Mincer F, Botstein C. Long survival in patients with bronchogenic carcinoma complicated by superior vena caval obstruction. Chest 1979; 75:325-9. [PMID: 84732 DOI: 10.1378/chest.75.3.325] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
When superior vena caval obstruction complicates cancer of the lung; the prognosis is grave; 1 percent of such patients survive for one year. Improved palliation is reported from many radiation therapy centers using higher initial dose fractions and tumoricidal doses. We now report the findings in three patients with histologically confirmed bronchogenic carcinoma who had superior vena caval obstruction and who survived for nine years (two patients) and seven years (one patient). Aggressive therapy with irradiation seems to provide better palliation and may occasionally be associated with remarkably long survivals in this normally highly lethal disease.
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26
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Morris AL, Barwinsky J. Unusual vascular complications of dissecting thoracic aortic aneurysms. CARDIOVASCULAR RADIOLOGY 1978; 1:95-100. [PMID: 743708 DOI: 10.1007/bf02552002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Nondissecting, chronic, thoracic aortic aneurysms (TAA) may be associated with such vascular complications as aorto-cardiac, aorto-superior vena caval (SVC) and aorto-pulmonary arterial (PA) fistual formation, and/or SVC or PA compression. Dissecting TAA have been associated with these lesions far less often. This report summarizes the occurence and outcome of the following complications of dissecting TTA: (1) SVC obstruction; (2) aorto-right and -left atrial, aorta-right ventricular and aorto-PA fistula formation; (3) compression of the PA and (4) hematoma of the interatrial septum. Two patients are described with aortic dessection complicated by: (1) SVC obstruction and aorto-left atrial fistula; and (2) aorto-PA fistula. These complications are rarer with aortic dissection, because of the acute, catastrophic nature of this lesion. When dissection is chronic, however, arteriovenous fistulae are often well tolerated, and urgent surgical intervention seems to be unnecessary.
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27
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Gomes MN, Hufnagel CA. Superior vena cava obstruction: a review of the literature and report of 2 cases due to benign intrathoracic tumors. Ann Thorac Surg 1975; 20:344-59. [PMID: 1164079 DOI: 10.1016/s0003-4975(10)64229-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A review of the literature shows an increaseing number of cases of superior vena cava obstruction associated with malignancy and a marked decrease in the number of patients with caval obstruction of benign origin. In contrast to granulomatous diseases and aneurysms of the ascending thoracic aorta, which have decreased, the incidence of benign tumors is essentially unchanged. Clinical features of superior vena cava obstruction in relation to the anatomical site of obstruction and collateral pathways are correlated. Diagnostic approaches, including angiography and technetium scanning are usually definitive in outlining the site of obstruction. Experimental data and the numerous available techniques for surgical correction indicate that an entirely satisfactory procedure is not available for all patients. Methods include the use of venous bypass or Teflon prostheses and the addition of a small arteriovenous fistula proximally. Two new cases of superior caval obstruction due to benign tumor are reported. In 1 patient, who had intrapericardial bronchogenic cyst with fibrotic caval obstruction and thrombosis, a method for caval reconstruction while maintaining venous return to the right atrium is described. The second patient had an intrathoracic thyroid adenoma and caval obstruction without thrombosis.
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Abstract
Benign superior vena cava (SVC) obstruction is an uncommon entity. However, it is important to recognize that a small percentage of SVC syndromes are due to benign diseases such as mediastinal granulomas. The insidious onset and slow progression of symptoms allow for development of an efficient collateral venous circulation compatible with long-term survival. Surgical intervention to bypass the obstruction is often unsuccessful and should be avoided in most cases. We review the English literature on the subject, classify the various causes of benign SVC syndrome, and report our experience with 16 documented cases.
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30
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Shah-Mirany J, Mirhoseini M, Head LR. Fatal pulmonary embolism from jugular veins following benign superior vena cava syndrome. Ann Thorac Surg 1971; 11:238-42. [PMID: 5546096 DOI: 10.1016/s0003-4975(10)65444-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Strax TE, Ryvicker MJ, Elguezabal A. Superior vena caval syndrome due to a mediastinal hematoma secondary to a dissecting aortic aneurysm. Calif Med 1969; 55:338-41. [PMID: 5775751 DOI: 10.1378/chest.55.4.338] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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