ppt lia scv

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    SUPERIOR VENA CAVA

    SYNDROME

    Nurmalia rizky zahra

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    SVC Syndrome

    Constellation of signs and symptoms caused byobstruction of blood flow in the superior venacava.

    Secondary to external compression, invasion,

    constriction or thrombosis of the SVC Can be partial or complete obstruction

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    SCVS (cont)

    Leads to increased venous pressure and resultsin edema of the head, neck, arms, and upperchest

    Dilated veins on the chest wall

    Pleural/pericardial effusions

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    Patients

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    Patients

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    Clinical Features of SVC

    SYMPTOMS FREQUENCY

    Short of Breath 50%

    Chest Pain 20%

    Cough 20%

    Dysphagia 20%Swelling 30%

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    Clinical Features of SVCS

    SIGNS FREQUENCY

    Thorax Vein Distention 70%Neck Vein Distention 60%Facial Swelling 45%UE/Trunk Swelling 40%Cyanosis 15%Markman, M. Cleveland Clinic Journal of Medicine, 1999

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    A/P #1

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    A/P #2

    Formed by merger of left/right brachiocephalicveins + azygous

    Venous blood from head/neck/upperextremities

    6 to 8 cm in length 1.5 to 2 cm wide

    Abner, A. Chest, 1993

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    A/P #3

    SVC surrounded by rigid structures (iemediastinum, sternum, right mainstembronchus and LN)

    Thin walled and easily compressible secondary

    to low pressureProne to obstruction relative to its neighbors

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    A/P #4

    As obstruction develops, venous collaterals form

    Alternate pathways for venous return to the RA

    Severity of sx depends on the time course ofobstruction

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    Etiology of SVC Malignancy

    Lung cancer

    Lymphoma

    Thymoma

    Metastatic

    Germ Cell

    Benign

    Infection/Inflammation

    Benign Neoplasms

    Iatrogenic

    Trauma

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    Mediastinitis

    Histoplasmosis 50%

    Fibrosing mediastinitis

    Others 50%

    TB

    Actinomycosis

    Syphilis

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    Diagnosis

    Chest radiograph

    Duplex ultrasound

    CT/MRI/MRV

    Venogram

    Radionuclide studies

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    Chest Radiograph

    CXR FINDINGS FREQUENCY

    Mediastinal Mass

    or Widening 59-84%

    Hilar LAD 19-50%

    Pleural Effusions 25%

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    CT/MRI/MRV

    Provide accurate info on location obstruction

    Determine etiology of obstruction

    Info on the extent of collaterals

    Guide biopsy attempts

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    Venography

    Can give precise level of obstruction

    Less information on etiology of SVCS

    Requires larger contrast dose

    Usually done during IR mgmt

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    Tissue Diagnosis

    Procedure Yield

    Sputum cytology 33-40%

    Bronchoscopy 33-60%

    LN biopsy 46-80%

    Mediastinoscopy 100%

    Thoracotomy 100%

    Ostler, J. Clin Onc, 1997

    Schindler, N. Surg Clin N Am, 1999

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    Treatment

    Tailored to etiology

    Emergent tx before tissue dx 2/2 presumed riskof bleeding

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    Treatment

    Goal

    treat symptoms

    treat underlying cause

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    Treatment

    Chemotherapy

    Surgery

    Interventional Procedures

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    Treatment

    Chemo

    Combination of chemo and radio teraphy

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    Surgical Tx

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    IR Treatment

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    IR Tx #3

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    Prognosis

    Varies depending on the etiologySVCS in its own right is rarely fatal10-20% survive at least 2 years

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    Prognosis

    Lung Cancer 79%, Lymphoma 18%, Other 6%

    XRT+/- chemotherapy

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    Prognosis Overall

    Median Survial=5.5 months

    1 year survival=24%

    5 year survival= 9%

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    Prognosis-Lymphoma

    1 year survival=41%

    5 year survival=41%

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    Prognosis

    No statistical difference in survival ratesbetween patients treated with chemoradiation vs

    either tx alone Pts who responding clinically within 30days of

    treatment had better 1 year survival (27% vs 7%)

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    thank you