Guidelines for the management of superior vena cava obstruction
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Superior vena cava obstruction Superior vena cava obstruction (SVCO) is generally caused by extrinsic compression by metastases in upper mediastinal lymph nodes. It may also be caused by tumour infiltration or thrombus. 95% of SVCO is caused by malignancy (80% due to lung cancer). Venous thrombosis can cause an acute onset of symptoms.
• Dyspnoea • Neck and facial swelling • Head fullness / headache • Trunk and arm swelling • Cough
• Dysphagia Signs • Thoracic vein distension 65% • Neck vein distension 55% • Tachypnoea • Plethora 15% • Facial / conjunctival oedema 55% • Central / peripheral cyanosis 15% • Arm oedema 10% • Vocal cord paresis 3% • Horner’s syndrome 3% Investigations • Assess for hypoxia • CXR – bulky mediastinal shadow, pleural/pericardial effusion • CT chest assess level of obstruction differentiate between thrombosis and tumour differentiate between compression and infiltration • Venous angiogram discuss with oncology and radiology consultant • Blood tests blood gases FBC, U&E, LFT. Clotting screen. Serum calcium. Uric acid tumour markers: Beta HCG, AFP, LDH, CEA, CA15-3 • Histology it is necessary to have histological confirmation before starting treatment. Urgent discussion must be carried out with oncology, radiology and thoracic surgery consultants regarding the optimal way to obtain histology.
St Elizabeth Hospice 565 Foxhall Road Ipswich IP3 8LX t 01473 727776 e enquiries@stelizabethhospice.org.uk www.stelizabethhospice.org.uk Yüklə 237,29 Kb. Dostları ilə paylaş:
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