Superior Venacava Syndrome

It is array of symptoms caused by obstruction of blood flow through the venacava superior to the right atrium.

Causes:

• External pressure- Carcinoma lung, lymphoma, metastasis within mediastinum, other primary mediastinal tumors
• Thrombosis of SVC
• Tuberculosis
• Central line thrombosis
• Idiopathic fibrosing mediastinitis

Clinical features:

• Swelling of face, neck and upper extremities
• Increased JVP
• Cyanosis
• Facial plethora
• Head ache
• Cough, shortness of breath
• Dizziness
• Swelling of tongue
• Distorted vision
• Rarely laryngeal edema
• Distended jugular vein
• Chemosis and papilledema

Investigations:

• Chest X ray- Widening of superior mediastinum, pleural effusion
• CT scan- Reduced/ absent opacities of central venous structures
• Biopsy and confirmation of diagnosis

Treatment

• Supportive treatment
  • Low salt diet
  • Head end elevation
  • Oxygen
  • Diuretics
• Radiation for non-small cell carcinoma of lung
• Chemotherapy for small cell carcinoma of lung and lymphoma
• If there is thrombosis- Anticoagulation

Malignant Pericardial Effusion

Causes:

• Lung carcinoma, breast malignancy, lymphoma
• ATRA therapy in APML
• Radiation induced
• Hypothyroidism
• Autoimmune disorders
• Infection
• Uremia
• Idiopathic pericardial disease

Clinical features:

• Slowly expanding effusion- Weakness, fatigue, dyspnea
• Rapidly expanding- Hemodynamic collapse (Hypotension, tachycardia, increased JVP, dull heart sounds)

Investigations:

• ECG: Sinus tachycardia with reduced voltage
• Chest X ray- Enlarged cardiac silhouette in globular/ symmetric fashion
• Transthoracic echocardiography
• CT scan/ MRI 

Treatment:

• Pericardiocentesis: Percutaneous/ subxiphoid, Under echo guidance
• Until this is done- IV fluid boluses and ionotropic support
• Radiation for radiosensitive tumors (Lymphoma, leukemia)