1. SVC Syndrome Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

2. 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

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

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

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

6. Diagnostic Methods Bronchoscopy Lymph node biopsy Sputum cytology Pleural biopsy Thoracotomy Bone marrow biopsy

7. Treatment of SVC Syndrome Radiotherapy Chemotherapy : Small cell Ca, Lymphoma Diuretics Corticosteroid Endovascular Stents

8. Prognosis Poor Inoperable Not treated : 3- 4 weeks If treated : about 10 months

9. SVC Invasion by Lung Cancer

11. SVC Syndrome and the stents

12. Lymphoma with SVC SD F/26 DOE for 2 months

13. Lymphoma with SVC SD

15. 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

16. Fibrosing Mediastinitis F/29 with SVC Syndrome by Histoplasmosis

17. Fibrosing Mediastinitis F/29 with SVC Syndrome by Old Histoplasmosis