SVC Syndrome
Sung Chul Hwang, M.D.
Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
Introduction
• A medical entity where compression of SVC
by various causes brings clinical symptoms
and signs of facial, upper body edema,
formation of collateral circulations, and
causes cyanosis and dyspnea
• 1757 William Hunter
• Malignancy– most common
• Fibrosing mediastinitis
Etiology
1)
2)
3)
4)
5)
6)
Malignancy
66/86 (YUMC)
Mediastinal fibrosis 2
Thrombosis
1
Inflammatory
0
Radiation fibrosis
0
Unknown
31
Symptoms and Signs
1)
2)
3)
4)
5)
6)
7)
8)
Suffusion
Dyspnea
Cough
Pain
Neck Vein Distention
Venous engorgement
Edema
Cyanosis
Diagnosis
•
•
•
•
History
Physical Examination
X-rays and CT Scans
Tissue Diagnosis
Diagnostic Methods
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•
•
•
•
•
Bronchoscopy
Lymph node biopsy
Sputum cytology
Pleural biopsy
Thoracotomy
Bone marrow biopsy
Treatment of SVC Syndrome
• Radiotherapy
• Chemotherapy : Small cell Ca,
Lymphoma
• Diuretics
• Corticosteroid
• Endovascular Stents
Prognosis
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•
•
•
Poor
Inoperable
Not treated : 3- 4 weeks
If treated : about 10 months
SVC Invasion by Lung Cancer
SVC Invasion by Lung Cancer
SVC Syndrome and the stents
Lymphoma with SVC SD
F/26 DOE for 2 months
Lymphoma with SVC SD
Lymphoma with SVC SD
Fibrosing Mediastinitis
• 20- 40 years
• Cough, Dyspnea, or Hemoptysis
• Most common cause of Benign SVC
syndrome
• Almost always remote Histoplasmosis
• Plain X-rays may be normal or only minimal
changes
• Partially calcified Mass on CT is diagnostic
Fibrosing Mediastinitis
F/29 with SVC Syndrome by Histoplasmosis
Fibrosing Mediastinitis
F/29 with SVC Syndrome by Old Histoplasmosis