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Superior Vena Cava Syndrome

Superior Vena Cava Obstruction

Superior vena cava syndrome is a form of vessel obstruction that occurs as a result of mechanical compression or due to thrombosis. Symptoms include facial edema, dyspnea, cough, neck distension, hoarseness and dysphagia, while severe cases may present with coma and severe respiratory distress. The diagnosis can be made clinically, but imaging studies are recommended for confirmation. Treatment depends on the underlying cause.


Presentation

Symptoms of SVCS depend on the severity and rapidness of vessel pathology. Most common symptoms include a sense of fullness in the head, neck and facial swelling, dyspnea, chest pain, cough, dysphagia and distended upper extremities [10]. Tachycardia, hoarseness, stridor, respiratory distress and cerebral edema with ischemia and herniation may be encountered in severe cases. Physical examination can reveal distended neck veins, edema of the upper extremities, while various neurological deficits may be encountered.

Hodgkin Lymphoma
  • Causes were as follows: small cell lung cancer (SCLC) 28.2 %, non-small cell lung cancer 25 %, non-Hodgkin's lymphoma 25 %, metastasis of other malignant tumors 19.4 % and Hodgkin's disease 2.4 %.[ncbi.nlm.nih.gov]
  • Lung cancer, usually small cell carcinoma, comprises 75-80% of these cases and non-Hodgkin lymphoma, most commonly diffuse large B-cell lymphoma, comprises 10-15%.[en.wikipedia.org]
  • Five patients had non-Hodgkin's lymphoma, two had Hodgkin's disease, two had benign lesions, and one patient was suspected on clinical and radiologic basis to have a lymphoma.[pediatrics.aappublications.org]
Fatigue
  • A 58-year-old man presents with a 2-week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. There is no history of syncope or dysphagia. He smoked cigarettes until 5 years ago.[doi.org]
  • Abstract Background A 29-year-old woman presented with chest pressure, progressive dyspnea, fatigue, and swelling of her face, neck and upper extremities.[nature.com]
  • Chronic cough may cause severe pain, trouble sleeping, dyspnea, or fatigue. The causes of chronic coughing are almost the same as the causes of dyspnea. It may be possible to treat the cause of chronic coughing.[cancer.gov]
  • […] relief at 5 days after the first fraction, and after the second fraction 74 % of patients reported that their symptoms had entirely disappeared. 22 % of patients reported treatment-associated nausea, 26 % reported WHO grade I–II dysphagia, 17 % reported fatigue[springerplus.springeropen.com]
Falling
  • In the case of life-threatening SVC obstruction chemotherapy can begin immediately (after the collection of material for histology) from vital indication (so called not fall submission).[telemedicina.med.muni.cz]
  • Pape Diadie Fall 2, Mouhamadou Chérif Mboup 2, Khadidiatou Dia 2, Malick Bodian 1 and Modou Jobe 1 Email author Thrombosis Journal 2015 13 :7 Sarr et al.; licensee BioMed Central. 2015 Received: 9 June 2014 Accepted: 20 January 2015 Published: 31 January[thrombosisjournal.biomedcentral.com]
Malaise
  • Table 2 Kishi Scoring system Neurological signs Awareness disorders or coma 4 Visual disorders, headache, vertigo or memory disorders 3 Mental disorders 2 Malaise 1 Thoracic or pharyngeal - laryngeal signs Orthopnea or laryngeal edema 3 Stridor, dysphagia[springerplus.springeropen.com]
Cough
  • The most frequent signs and symptoms were face or neck swelling (82%), upper extremity swelling (68%), dyspnea (66%), cough (50%), and dilated chest vein collaterals (38%).[ncbi.nlm.nih.gov]
  • They include head, neck and arm oedema, often with cyanosis, headache, confusion and coma, distended subcutaneous veins, cough and hoarseness, and difficulty in breathing and swallowing.[medical-dictionary.thefreedictionary.com]
Dyspnea
  • The most frequent signs and symptoms were face or neck swelling (82%), upper extremity swelling (68%), dyspnea (66%), cough (50%), and dilated chest vein collaterals (38%).[ncbi.nlm.nih.gov]
Hoarseness
  • Classic symptoms include edema, plethora, and distended veins of the face, neck, and chest; shortness of breath; cough; headache; and hoarseness. Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids.[ncbi.nlm.nih.gov]
  • Severe cases present with hoarseness, laryngeal edema and neurological deficits.[symptoma.com]
  • Common childhood SVCS symptoms are similar to what adults experience and may include: Coughing Hoarseness in voice Trouble breathing Chest pain Related Resources Heart Problems More Information National Cancer Institute: Cardiopulmonary Syndromes[cancer.net]
  • Social considerations Patients and family members are often frightened and anxious because of the symptoms of SVCS, mainly swelling, trouble swallowing, coughing, and hoarseness.[healthinfo.uclahealth.org]
Stridor
  • Stridor is not present. How should his case be evaluated and managed? Funding and Disclosures No potential conflict of interest relevant to this article was reported. We thank Marilyn L.[doi.org]
  • Shortness of breath and coughing are quite common symptoms; difficulty swallowing is reported in 11% of cases, headache in 6% and stridor (a high-pitched wheeze) in 4%.[en.wikipedia.org]
  • The only truly emergent situation in adults is the patient presenting with stridor or other signs of severe airway compromise or the patient with cerebral edema or hemodynamic compromise.[clinicaladvisor.com]
  • Exception Patients who present with stridor due to central airway obstruction severe laryngeal edema, and those with coma from cerebral edema.[slideshare.net]
Pleural Effusion
  • Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed.[ncbi.nlm.nih.gov]
  • European Respiratory Journal 1997 10: 1675-1677; DOI: Abstract Pleural effusion is often a manifestation of the superior vena cava (SVC) syndrome. However, pleural effusion has never been reported to be a cause of the SVC syndrome.[erj.ersjournals.com]
  • Patients may experience complications such as laryngeal edema, cerebral edema, upper airway compression, cardiac infiltration by malignancy, cardiac tamponade, and pleural effusion, leading to poor outcomes.[oncologynurseadvisor.com]
Chest Pain
  • A six months' follow-up revealed abolishment of chest pain and superior vena cava (SVC) syndrome and good prosthetic composite graft function with no recurrence of pseudo aneurysm or dissection.[ncbi.nlm.nih.gov]
  • Dyspnea at rest, cough, and chest pain were more frequent in the patients with malignancy. Procedures performed for diagnostic or treatment purposes did not increase morbidity or mortality.[doi.org]
  • Abstract A 31-year-old woman was admitted to our hospital with a sudden onset of chest pain and dyspnea. Echocardiography, chest CT, and chest MRI revealed a huge mass in the right atrium.[jstage.jst.go.jp]
Cyanosis
  • It is also associated with cyanosis, plethora, and distended subcutaneous vessels. Lung cancer, including both non-small cell lung cancer and small cell lung cancer, is the most common extrinsic cause of superior vena cava syndrome.[ncbi.nlm.nih.gov]
  • The increased venous pressure results in oedema of the head, neck, and arms, often with cyanosis, plethora, and distended subcutaneous vessels. [1] Wilson LD, Detterbeck FC, Yahalom J.[bestpractice.bmj.com]
  • They include head, neck and arm oedema, often with cyanosis, headache, confusion and coma, distended subcutaneous veins, cough and hoarseness, and difficulty in breathing and swallowing.[medical-dictionary.thefreedictionary.com]
  • Cyanosis and respiratory distress mandates adequate supplementation of oxygen and assisted ventilation in severe cases, while rest, fluid administration, use of diuretics and glucocorticoids is shown to be of great benefit for patients..[symptoma.com]
  • Other symptoms are cough, facial swelling, arm swelling, chest pain, dysphagia and hoarseness, cyanosis, cerebral edema, and mental status changes.[clinicaladvisor.com]
Vascular Disease
  • Continued Other Vascular Diseases Your circulatory system is made up of the vessels that carry blood to every part of your body. Vascular disease includes any condition that affects your circulatory system.[webmd.com]
  • Signs and symptoms include a nonproductive cough, breathing difficulty, cyanosis, central nervous system disorders, and edema of the conjunctiva, trachea, and esophagus. superior vena cava syndrome Superior vena cava obstruction, SVC obstruction Vascular[medical-dictionary.thefreedictionary.com]
  • Treatment of noncoronary obstructive vascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 66.[nlm.nih.gov]
Distended Neck Veins
  • Physical examination can reveal distended neck veins, edema of the upper extremities, while various neurological deficits may be encountered.[symptoma.com]
  • She was orthopnoeic and had distended neck veins, but air entry was normal in both lungs. Chest radiography showed a widened mediastinum with a mass taking up half the right hemithorax.[anesthesiology.pubs.asahq.org]
Flushing
  • With acute superior vena cava obstruction, symptoms include facial and neck swelling, facial flushing, bilateral upper extremity swelling, neurological signs, dyspnea, headache, and cough.[radiopaedia.org]
Upper Extremity Swelling
  • The most frequent signs and symptoms were face or neck swelling (82%), upper extremity swelling (68%), dyspnea (66%), cough (50%), and dilated chest vein collaterals (38%).[ncbi.nlm.nih.gov]
  • With acute superior vena cava obstruction, symptoms include facial and neck swelling, facial flushing, bilateral upper extremity swelling, neurological signs, dyspnea, headache, and cough.[radiopaedia.org]
  • ., the mean age was found to be 55 years. [20] The diagnosis of SVCS is mainly based on clinical findings. [14], [22] Facial puffiness and neck swelling are the most common presenting symptoms. [5], [22] Other commonly noted symptoms are upper extremity[cancerjournal.net]
Edema of the Upper Extremity
  • Physical examination can reveal distended neck veins, edema of the upper extremities, while various neurological deficits may be encountered.[symptoma.com]
  • Clinical signs include cyanosis, plethora, distention of and missing positional emptying of subcutaneous vessels, and edema of the upper extremities, head, and neck.[rc.rcjournal.com]
Facial Swelling
  • Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed.[ncbi.nlm.nih.gov]
Neck Swelling
  • The most frequent signs and symptoms were face or neck swelling (82%), upper extremity swelling (68%), dyspnea (66%), cough (50%), and dilated chest vein collaterals (38%).[ncbi.nlm.nih.gov]
Facial Edema
  • Symptoms include facial edema, dyspnea, cough, neck distension, hoarseness and dysphagia, while severe cases may present with coma and severe respiratory distress.[symptoma.com]
  • RESULTS: The main clinical manifestations were dyspnea (84.7%), facial edema (81.9%), arm edema (22.2%), neck vein distension (25%), hoarseness (12.5%) and facial plethora (5.6%).[e-roj.org]
  • Patient with a 4-week history of increasing facial edema and known lung cancer. Chest radiograph of a patient with known superior vena cava syndrome (SVCS) and bronchogenic carcinoma (CA).[emedicine.medscape.com]
Neck Edema
  • We recommend that the patient's head be raised to decrease hydrostatic pressure and head and neck edema, though this approach is not backed by data.[rc.rcjournal.com]
  • Supportive care and medical management No data documenting the effectiveness of this maneuver, the head should be raised to decrease hydrostatic pressure and head and neck edema. Obstruction of blood flow through the SVC slows venous return.[slideshare.net]
Collar of Stokes
  • Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass.[ncbi.nlm.nih.gov]
  • […] of Stokes Pemberton's signSuperior vena cava syndrome usually presents more gradually with an increase in symptoms over time as malignancies increase in size or invasiveness.[en.wikipedia.org]
Headache
  • Classic symptoms include edema, plethora, and distended veins of the face, neck, and chest; shortness of breath; cough; headache; and hoarseness. Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids.[ncbi.nlm.nih.gov]
  • Shortness of breath and coughing are quite common symptoms; difficulty swallowing is reported in 11% of cases, headache in 6% and stridor (a high-pitched wheeze) in 4%.[en.wikipedia.org]
  • Background: SVCS causes increased venous pressure which can cause intracerebral manifestations including headaches, papilledema and rarely, cerebral edema.[neurology.org]
Altered Mental Status
  • Stridor, edema, shortness of breath, difficulty swallowing, visual disturbances, headache, and altered mental status were not present. Labs revealed a normal CBC and BMP.[karger.com]

Workup

Because SVCS can mimic various conditions, including pericarditis, heart failure, myocardial infarction (if symptoms appear abruptly) and ischemic stroke, the diagnostic workup should start with a full physical examination and proper patient history. Information about comorbidities, history of previous surgical procedures and underlying diseases such as malignant tumors (which may not be diagnosed yet, in which case a high clinical suspicion is necessary) should be obtained in full, whereas physical examination may provide key details in making the diagnosis. These tools, however, may only make an initial diagnosis that needs to be confirmed with imaging studies. Plain radiography may reveal the presence of a tumor, but CT, venography, or MR angiography are recommended methods in confirming the diagnosis [4]. If a tumor is suspected, biopsy with subsequent histopathological evaluation is necessary to determine the subtype. Through these methods, the exact cause may be determined, after which appropriate treatment can be instated.

Mediastinal Mass
  • Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass.[ncbi.nlm.nih.gov]
  • Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass.[joacp.org]
  • Enhanced CT shows the location and severity of the SVC obstruction, superimposed thrombosis, a mediastinal mass or lymphadenopathy, collateral vessels and associated lung masses.[radiopaedia.org]
Normal Chest X-Ray
  • However, 16% of people with SVC syndrome have a normal chest X-ray. CT scans should be contrast enhanced and be taken on the neck, chest, lower abdomen, and pelvis.[en.wikipedia.org]
Sinus Arrest
  • We describe a case of balloon angioplasty and stenting for SVC syndrome in a dialysis patient that resulted in sinus arrest. The complication developed within hours of angioplasty/stenting of her chronic, non-thrombotic SVC obstruction.[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • Here we describe a patient with an allergy to iodinated contrast material (ICM) who presented with SVC syndrome owing to mediastinal lymph node metastases from hepatocellular carcinoma, which was successfully treated with an SVC stent.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed.[ncbi.nlm.nih.gov]
  • European Respiratory Journal 1997 10: 1675-1677; DOI: Abstract Pleural effusion is often a manifestation of the superior vena cava (SVC) syndrome. However, pleural effusion has never been reported to be a cause of the SVC syndrome.[erj.ersjournals.com]
  • Patients may experience complications such as laryngeal edema, cerebral edema, upper airway compression, cardiac infiltration by malignancy, cardiac tamponade, and pleural effusion, leading to poor outcomes.[oncologynurseadvisor.com]

Treatment

Management of patients initially necessitates supportive measures. Cyanosis and respiratory distress mandates adequate supplementation of oxygen and assisted ventilation in severe cases, while rest, fluid administration, use of diuretics and glucocorticoids is shown to be of great benefit for patients. [4]. The mainstay of therapy, however, is identification and treatment of the underlying cause. In the setting of thrombosis, anticoagulant and thrombolytic therapy consisting of either warfarin or heparin is effective [3], whereas removal of central venous catheters and pacemakers should be considered. Infectious pathogens such as histoplasmosis and tuberculosis require intensive antifungal and antibiotic therapy, respectively. As tumors are the most common cause, appropriate staging of the tumor and adequate therapy consisting of surgery, radiation and/or chemotherapy are vital in eliminating the mass that compresses the superior vena cava. Various techniques for isolated management of SVCS have been described across many studies, with endovascular approaches being recommended as first-line therapy [11]. Insertion of vascular endoprostheses and resection and reconstruction of the venous vessel using autologous tissue are some of the most successful [6] [12] [13].

Prognosis

The prognosis of patients with SVCS directly depends on the underlying cause. If malignancy triggers SVCS, overall prognosis is poor. Studies have established that SVCS is a predictor of poor outcome in patients suffering from non-small cell lung cancer [7]. On the other hand, central venous catheter-induced thrombosis can be resolved quickly, which is why identifying the cause as soon as possible may significantly improve the outcome [9].

Etiology

SVCS was initially described more than 250 years ago [5], and numerous causes have been described in literature. Studies have shown two pathologic events: extraluminal mechanical compression of the vein that causes narrowing of the vessel lumen and thrombosis [3]. Malignant tumors, most frequently bronchogenic carcinoma, but also lymphoma, chondrosarcoma [6], melanoma and breast cancer are responsible for approximately 85% of all SVCS cases, while mediastinal metastases and enlarged lymph nodes may also compress the superior vena cava [7]. Non-malignant causes are much more uncommon and comprise about 15% of cases. Infectious pathogens such as tuberculosis and histoplasmosis, thymomas, aortic aneurysms, mediastinal fibrosis (that may be a consequence of histoplasmosis), as well as central venous and pacemaker catheters are causative agents in approximately 15% of patients [7]. Recent reports, however, suggest that benign causes may be responsible for up to 40% of cases, primarily because of increasing use of central venous catheters and pacemakers that can lead to thrombosis [2].

Epidemiology

Because of the underlying etiologies, SVCS is established to be most common in males between 50-70 years of age with either primary or metastatic tumors of the mediastinum [3]. Certain studies have established that approximately 15,000 individuals develop SVCS in the United States every year [7]. Advanced malignant disease is the single most important risk factor for SVCS, but several other have been established. Right-sided tumors, due to anatomical proximity to the vessel, are more likely to cause SVCS [3]. Placement of central venous catheters [8], as well as implantation of cardiac pacemakers are significant risk factors for SVCS as these methods induce hypercoagulable states that lead to obstruction.

Sex distribution
Age distribution

Pathophysiology

Under physiological conditions, venous blood from the head, upper thorax and the arms drain into the superior vena cava, which eventually terminates in the right atrium, making it one of the most important venous vessels in the body. It is tightly enclosed in the anterior superior mediastinum by several structures [3], including the sternum, the trachea, right mainstem bronchus, thoracic aorta, and both perihilar and paratracheal lymph nodes. In most cases, SVCS stems from either mechanical extraluminal compression by a malignant tumor or thrombosis [3]. In case of compression, narrowing of the vessel lumen occurs, while thrombosis reduces the diameter through which blood can pass, both eventually elevating venous pressures. As a compensatory mechanism, the body redistributes circulation to tributaries of the superior vena cava, such as the azygous vein, in the attempt to reduce vessel overload. As the underlying cause is not resolved, however, severe compression or occlusion eventually triggers the onset of symptoms.

Prevention

Timely diagnosis of the underlying cause may significantly reduce the rate of SVCS appearance, but directed preventive strategies may be aimed at regular screening of patients who are at risk, such as those with malignant tumors that are known to induce this vascular phenomenon, but also those with central venous catheters and pacemakers.

Summary

Superior vena cava syndrome (SVCS) is a clinical entity in which mechanical obstruction of the superior vena cava leads to reduced blood flow. In up to 85% of all cases, SVCS stems from mechanical compression by malignant tumors, while other etiologies include mediastinal fibrosis, use of cardiac pacemakers and central venous catheters that predispose patients to thrombosis [1]. Bronchogenic carcinoma is by far the most common tumor, followed by small-cell carcinomas, non small-cell carcinomas, lymphomas and various other [2]. The superior vena cava is responsible for drainage of the upper portions of the thorax, the arms and the endocranium. In the setting of mechanical compression or thrombosis, there is an increased load on the accessory veins, including vertebral, internal mammary and the thoracic venous system, but the azygous vein is the single most important collateral branch [3]. Eventually, increased venous pressure develops and various symptoms may appear depending on the progression and severity of obstruction. Facial edema, dyspnea, cough, dysphagia together with neck and upper extremity distension are most frequently reported [4]. Severe cases present with hoarseness, laryngeal edema and neurological deficits [3]. Physical examination may reveal distended neck veins, tachycardia, swelling of the face and upper extremities, whereas patients suffering from severe forms may develop respiratory distress, altered mental state, seizures and coma [3]. Although the diagnosis can be made based on clinical criteria, imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), MR angiography, venography and even plain radiography may be used to confirm the diagnosis and the underlying cause. Since tumors are the most common cause of obstruction, biopsy with subsequent histopathological examination is required to determine the exact tumor subtype. Treatment is aimed at resolving the cause. Radiation, surgery and chemotherapy are used in the case of malignancy, while supportive measures include oxygen therapy and use of diuretics, thrombolytic agents and corticosteroids [3].

Patient Information

Superior vena cava syndrome (SVCS) is a condition in which one of the most important veins, the superior vena cava, is either mechanically compressed or affected by thrombosis, leading to impaired blood flow and appearance of various symptoms. This vein collects blood from the entire head and neck, as well as the upper extremities and the upper part of the chest that reaches the right atrium, from where it travels to the lungs, back to the heart and into the circulation through the aorta. The most common cause of SVCS is a malignant tumor, comprising about 85% of all cases, with lung cancer being the most common type of malignancy. The presence of a tumor causes compression of the vessel and narrows the lumen through which blood can pass. Thrombosis due to placement of central venous catheters (often instated in intensive care patients and many other) or pacemakers can also trigger SVCS, as thromb formation impedes normal blood flow. To compensate for reduced blood flow, the body attempts to redistribute blood via several tributaries of the superior vena cava, but eventually, symptoms such as head and neck swelling, breathing difficulties and chest pain appear. In severe cases, voice changes due to swelling of the larynx, tachycardia and neurological changes may be observed, which requires immediate treatment and identification of the underlying cause. To make a presumptive diagnosis, physical examination can reveal distended neck veins, cyanosis (blue discoloration of the skin due to impaired oxygen delivery of the heart) and swelling of the upper extremities, but imaging techniques such as X-ray, computed tomography (CT scan), venography and a specific form of magnetic resonance imaging (MRI), MR angiography, can be used. If a tumor is suspected, biopsy of the mass is necessary to determine the exact subtype. Treatment depends on the underlying cause, but supportive measures consisting of oxygen therapy, administration of anticoagulants, diuretics, corticosteroids and fluid replenishment are recommended. Surgery, radiation and chemotherapy are used in managing malignant tumors, while various surgical procedures for vessel repair have been described. The condition itself may not be of significant risk for patients, but the underlying diagnosis is cancer in the vast majority of cases, which is why poor outcomes are observed. This condition is most commonly seen in males between 50-70 years and about 15,000 Americans are diagnosed every year with SVCS. For these reasons, screening of patients that are already diagnosed with lung cancer, as well as those that have established risk factors may be an effective treatment strategy in reducing the burden of this condition.

References

Article

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  2. Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85(1):37-42.
  3. Flounders J. Superor vena cava syndrome. Oncol Nurs Forum. 2003;30(4):E84-88.
  4. Garg PK, Mohanty D. Malignant superior vena cava syndrome. Urol Ann. 2013;5(4):294-295.
  5. Hunter W. The history of an aneurysm of the aorta with some remarks on aneurysms in general. Med Obs Soc Phys Lond. 1757;1:323.
  6. García Mónaco R, Bertoni H, Pallota G, et al. Use of self-expanding vascular endoprostheses in superior vena cava syndrome. Eur J Cardiothorac Surg 2003;24:208.
  7. Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N. Superior vena cava syndrome: A medical emergency? Int J Angiol. 2008;17(1):43–46.
  8. Akoglu H, Yilmaz R, Peynircioglu B, et al. A rare complication of hemodialysis catheters: superior vena cava syndrome. Hemodial Int 2007;11:385–391.
  9. Katabathina VS, Restrepo CS, Betancourt Cuellar SL et al. Imaging of oncologic emergencies: what every radiologist should know. Radiographics. 2013;33(6):1533-1553.
  10. Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. 2007;25(1):2-5;
  11. Warren P, Burke C. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. Seminars in Interventional Radiology 2011;28(1):32–38.
  12. Lanuti M, De Delva PE, Gaissert HA, et al. Review of superior vena cava resection in the management of benign disease and pulmonary or mediastinal malignancies. Ann Thorac Surg. 200988(2):392-397.
  13. Wada N, Masudo K, Hirakawa S, et al. Superior vena cava (SVC) reconstruction using autologous tissue in two cases of differentiated thyroid carcinoma presenting with SVC syndrome. World J Surg Oncol. 2009;13;7:75.

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Last updated: 2019-07-11 20:20