Today in noon report we talked about a patient with an anterior superior mediastinal mass.
The differential for these can be remembered as the five Ts:
- thyroid mass
- thoracic aorta
- terrible lymphoma
Sometimes these masses can compress the Superior Vena Cava, causing SVC Syndrome.
Clinical Features of SVC Syndrome:
- Facial and neck edema, plethora
- Venous collaterals visible over chest
- Stridor, hoarseness, cough (edema causing pressure on larynx)
- Dysphagia (edema causing pressure on pharynx)
- Cerebral edema: headaches, confusion
Causes of SVC Syndrome: The first step is to distinguish thrombosis from extrinsic compression by a mass. This is usually done with a contrast CT scan. Thrombosis is usually a result of instrumentation (catheters, pacemaker wires) while compression is usually from malignancy (lung, lymphoma or metastatic).
Treatment of SVC Syndrome:
- radiation- when a tissue diagnosis has been made
- chemotherapy in non-Hodgkin's lymphoma and small cell lung cancer
- stenting by interventional radiology
- removal of hardware and/or local thrombolysis for acute thrombosis followed by anticoagulation (not indicated if chronic)
Check out this review of SVC syndrome from NEJM