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Superior vena cava syndrome from extensive lung cancer

  • Rohan Prasad EMAIL logo and Tyler Kemnic
Published/Copyright: February 11, 2021
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 121 Issue 3

A 49-year-old woman with thyroid cancer presented to an emergency department in September 2020 after three weeks of dyspnea. Her physical exam revealed bilateral flushing, facial swelling (Image A), and cervical adenopathy. She also displayed right-sided wheezes and rales. Chest and neck computed tomography imaging demonstrated a large, right-sided hilar mass occluding the superior vena cava (SVC) and left atrium along with a thrombus within the SVC and bilateral pleural effusions (Image B). Her echocardiogram illustrated a 60–65% ejection fraction, moderate pericardial effusion, and early signs of hemodynamic compromise. The patient underwent a supraclavicular lymph node biopsy and pericardial/pleural effusion drainage, with pathology reading stage 4 small cell lung cancer (SCLC). A regimen of heparin infusion, furosemide, cisplatin, etoposide, and radiation was begun. The patient was discharged from the hospital and is currently undergoing outpatient palliative chemoradiation. She had a relapse of bilateral facial swelling that was effectively treated outpatient with furosemide.

Image A: On admission, this 49-year-old woman’s face showed bilateral flushing and facial swelling.
Image A:

On admission, this 49-year-old woman’s face showed bilateral flushing and facial swelling.

Image B: (Top) The patient’s chest computed tomography (CT) angiography (coronal view/lung window) depicted a large, extensive right-sided hilar/perihilar mass that occluded the superior vena cava. The mass also projected into and occupied a major portion of the left atrium. Multiple right upper lobe nodules and bilateral pleural effusion were evident. Contiguous right hilar and mediastinal lymphadenopathy invaded the adjacent mediastinum. (Bottom) Neck soft tissue CT with contrast (axial view) depicted that the mass described in Part A encased the origins of the internal jugular vein, brachiocephalic artery, left common carotid artery, and left subclavian artery. A hypodense filling defect was seen within the superior vena cava and bilateral veins consistent with a thrombus.
Image B:

(Top) The patient’s chest computed tomography (CT) angiography (coronal view/lung window) depicted a large, extensive right-sided hilar/perihilar mass that occluded the superior vena cava. The mass also projected into and occupied a major portion of the left atrium. Multiple right upper lobe nodules and bilateral pleural effusion were evident. Contiguous right hilar and mediastinal lymphadenopathy invaded the adjacent mediastinum. (Bottom) Neck soft tissue CT with contrast (axial view) depicted that the mass described in Part A encased the origins of the internal jugular vein, brachiocephalic artery, left common carotid artery, and left subclavian artery. A hypodense filling defect was seen within the superior vena cava and bilateral veins consistent with a thrombus.

Thoracic neoplasm is the inciting etiology in 60% (47 of 78) of SVC syndromes, according to a previous study [1]. Typical symptoms include swelling (facial, neck, and arm), dyspnea, and cough.1 The prognosis of SVC syndrome largely depends on the etiology. When associated with SCLC, 77.6% (142 of 183) of patients in a previous study saw resolution with chemoradiation and there was a 16.7% (60 of 359) recurrence rate.2

Corresponding author: Rohan Prasad, DO, Department of Internal Medicine, Michigan State University – Sparrow Hospital, 1200 E Michigan Avenue, Lansing, MI, 48912, USA, E-mail:

  1. Research funding: None reported.

  2. Author Contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  3. Competing interests: Authors state no conflict of interest.

References

1. Rice, T, Rodriguez, M, Light, RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine 2006;85:37–42. doi: 10.1097/01.md.0000198474.99876.f0.10.1097/01.md.0000198474.99876.f0Search in Google Scholar PubMed

2. Rowell, NP, Gleeson, FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol 2002;14:338–51. doi: 10.1053/clon.2002.0095.10.1053/clon.2002.0095Search in Google Scholar PubMed

Received: 2020-11-29
Accepted: 2020-12-15
Published Online: 2021-02-11

© 2020 Rohan Prasad and Tyler Kemnic, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2020-0304
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Registering your research: What’s required?
  4. General
  5. Brief Report
  6. A survey on health professionals’ understanding of federal protections regarding service dogs in clinical settings
  7. Innovations
  8. Original Article
  9. The use of 3D printing for osteopathic medical education of rib disorders
  10. Medical Education
  11. Original Articles
  12. Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine
  13. The Philadelphia surgery conference: a value analysis of a hands-on surgical skill-building event
  14. Medical Education
  15. Brief Report
  16. Poor match rates of osteopathic applicants into ACGME dermatology and other competitive specialties
  17. Musculoskeletal Medicine and Pain
  18. Review Article
  19. Osteopathic model of the development and prevention of occupational musculoskeletal disorders
  20. Neuromusculoskeletal Medicine (OMT)
  21. Review Article
  22. Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review
  23. Public Health and Primary Care
  24. Original Article
  25. An analysis of research quality underlying IDSA clinical practice guidelines: a cross-sectional study
  26. Clinical Images
  27. Papillary fibroelastoma: an unexpected finding on the aortic valve
  28. Superior vena cava syndrome from extensive lung cancer
  29. Letter to the Editor
  30. New clinical research urgently needed for adjunctive OMT treatment in elderly patients hospitalized with COVID-19 pneumonia
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