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)Malignancy 66/86 (YUMC) 2)Mediastinal fibrosis 2 3)Thrombosis 1 4)Inflammatory 0 5)Radiation fibrosis 0 6)Unknown 31

Symptoms and Signs 1)Suffusion 2)Dyspnea 3)Cough 4)Pain 5)Neck Vein Distention 6)Venous engorgement 7)Edema 8)Cyanosis

Diagnosis History Physical Examination X-rays and CT Scans Tissue Diagnosis

Diagnostic Methods 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 Poor Inoperable Not treated : 3- 4 weeks If treated : about 10 months

SVC Invasion by Lung Cancer

SVC Syndrome and the stents

Lymphoma with SVC SD F/26 DOE for 2 months

Lymphoma with SVC SD

Fibrosing Mediastinitis 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