Diagnosis and treatment of superior vena cava syndrome

By | April 12, 2012

Superior vena cava syndrome with typical clinical features, the tumor was acute or subacute crisis, the general should be dealt with expeditiously to alleviate the symptoms, histology must obey the treatment. Obstruction is usually the result of extrinsic compression can also be directly due to tumor invasion, and venous blood flow is slow or long-term venous catheter thrombosis in the lumen caused by caused. Non-tumor diseases, such as aortic aneurysm, lymph node tuberculosis, substernal goiter, pericarditis and other causes of superior vena cava compression syndrome number of less than 3%.
Superior vena cava syndrome usually occurs as a latent resistance, acute attack, occurs when the special symptoms and signs. With the increased pressure on the vena cava, leading to the face, chest, neck superficial vein dilation, facial marks of blood, breathing difficulties or orthopnea and a variety of God: The system symptoms such as headache, visual disturbances and altered consciousness.
Acute superior vena cava syndrome diagnosis easier, just based on history and clinical manifestations can be set up, the ideal approach is for the histological diagnosis, which helps formulate a treatment plan for the source of the disease. Current chest X-ray, CT, MRI are easier to make a diagnosis of superior vena cava syndrome. Histological diagnosis by sputum cytology, bronchoscopy and biopsy, scalene lymph node biopsy, no surgery is necessary in clinical situations contraindication possible diagnostic mediastinoscopy or thoracotomy surgery.
Malignant superior vena cava obstruction is one of the emergency, first aid measures must be taken immediately. Current clinical treatment methods are mainly the following:
1. Radiation therapy: The first sub-high-dose radiation therapy for 3-4 days often have different degrees of improvement of symptoms within a week 90% of cases the symptoms improved. Malignant lymphoma than the general efficacy of lung cancer is good, if the effect is not significant, should pay attention to whether the thrombosis.
2. Chemical treatment: usually better in combination with radiotherapy, lymphoma, undifferentiated non-small cell lung cancer and germ cell spermatogonia are the first use of chemotherapy. Lymphoma of the mass is too large or small cell lung cancer or mediastinal radiation tolerance has reached the amount of the superior vena cava syndrome, the first chemotherapy to alleviate the symptoms. Tumor size after radiotherapy, can reduce the radiation field to protect the more normal lung tissue.
3. Surgical treatment: Most of the superior vena cava syndrome, radiotherapy or chemotherapy can be alleviated, superior vena cava graft shunt, more difficult, complications and mortality were high, only the application of radiotherapy and chemotherapy has not been satisfied with the results after caution.
Superior vena cava syndrome 4. symptomatic treatment with anti-clotting drugs oxygen, limiting the amount of liquid and sodium salt into the use of diuretics may improve edema. High-dose corticosteroids can temporarily relieve breathing difficulties, ease of tumor necrosis and radiation-related edema and inflammation, thus improving obstructive symptoms of lymphoma and small cell tumors had synergistic therapeutic effect. Thrombosis, it can add with fibrinolytic drugs, accelerate and improve clinical symptoms

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