Superior vena cava syndrome. Compression syndrome of the superior vena cava and its symptoms Quetiapine and superior vena cava syndrome

Superior vena cava syndrome is a disorder that is a violation of the outflow of venous blood from the upper torso (poor circulation). At the heart of such an ailment is the compression of a vein or the occurrence of a blood clot, which actually disrupts its outflow from the head, shoulders and upper half of the body. This can lead to the occurrence of serious complications that can threaten a person's life. Such a disorder is often diagnosed between the ages of thirty and sixty years (in males, several times more often than in women).

The main clinical manifestations diseases are - the appearance of a bluish tint on the skin, the formation of shortness of breath, a change in the timbre of the voice, swelling of the face and neck, shortness of breath, pain in the area chest as well as fainting or convulsive state... Secondary symptoms include hearing loss and visual acuity.

Diagnostic measures include performing X-ray, ultrasound, MRI, CT and other instrumental examinations of the chest. Treatment of the disease is aimed at eliminating pathology by conducting surgical operations.

Etiology

There are many reasons for the formation of such a pathology, the main of which are:

• external compression of the vein;
• thrombus formation;
• education malignant tumor the right lung is the main factor in the occurrence of such a pathology.

Other contributing factors may be:

• organ tumors digestive system of different nature that are in the area of ​​the diaphragm;

In addition, a similar disorder can be observed with the course of certain diseases. Among which:

• goiter of the retrosternal region;
• cardiovascular insufficiency;
• pathological effects of pathogens;
• a wide variety ;
• proliferation of fibrous tissue.

There is a possibility of an ailment occurring as a response of the body to surgery, as well as from prolonged use of a venous catheter.

Symptoms

Emergence characteristic features is caused by an increase in pressure in the vessels, and the degree of their manifestation is influenced by the rate of progression of the pathological process and the degree of circulatory disturbance. The main symptoms of the disease include:

• attacks of severe headache;
• shortness of breath not only when physical activity but also at rest;
• difficult breathing process;
• soreness in the retrosternal region;
• cyanosis of the upper body;
• change the timbre of the voice. Often he becomes hoarse, the person constantly wants to clear his throat;
• swelling of the face and neck;
• constant drowsiness and lethargy;
• the appearance of seizures;
• fainting.

Secondary signs of a similar syndrome are the patient's complaints of hearing loss and visual acuity, the occurrence of tinnitus, as well as auditory hallucinations and increased lacrimation. The intensity of the manifestation of symptoms is individual for each person, which is determined by the speed of the spread of the disease-causing process. The more the vein is squeezed, the smaller its lumen, which further impairs blood circulation.

Diagnostics

Diagnostic measures for the diagnosis of superior vena cava syndrome are based on instrumental examination of the patient. But before that, the doctor needs to read the medical history, find out possible reasons the formation of the disease, as well as the presence and degree of intensity of the manifestation of symptoms.

Instrumental diagnostic techniques include:

• chest x-ray. Pictures are taken in several projections;
• tomography - in particular, computed tomography, spiral and MRI;
• phlebography - performed to identify the location of the disease-causing process;
• USDG veins - such as carotid and supraclavicular;
• bronchoscopy - will help determine the causes of the formation of the disease, with the mandatory implementation of a biopsy;
• laboratory tests of sputum.

If necessary, a diagnostic thoracoscopy, mediastinoscopy and an ophthalmologist's consultation are prescribed, during which the intraocular pressure is measured. In addition, it is necessary to differentiate this pathology with congestive heart failure. After receiving all the examination results, the doctor prescribes the most effective treatment tactics for each patient.

Treatment

General therapeutic measures for all patients consist of constant oxygen inhalation, sedation drugs, diuretics and glucocorticoids, adherence to a low-salt diet and bed rest.

Further treatment for each patient is individual and depends on the causes of this syndrome:

• if the disease was caused by oncology of the right lung, metastases or other malignant neoplasms, then the patients are prescribed chemotherapy or radiation treatment;
• in cases of the formation of the disease against the background of thrombosis, thrombectomy is performed, often with the removal of the affected part of the vena cava, followed by the establishment of a homograft.

If it is impossible to carry out radical surgical operations, other methods of treatment are prescribed, aimed at restoring the outflow of venous blood:

• deletion benign neoplasm areas of the mediastinum;
• bypass shunting;
• percutaneous balloon angioplasty;
• stenting of the superior vena cava.

In most situations, the treatment of the disease is gradual and phased, but sometimes an urgent operation may be required. This is necessary when:

• acute, which can lead to cardiac arrest;
• obvious difficulty in performing respiratory functions;
• brain lesions.

There is no specific prevention of such a disease. The prognosis of the disease depends on the causes of such a disorder and the timely initiation of therapy. Elimination of progression factors allows you to completely get rid of the syndrome. The acute course of the disease can cause rapid death of a person. If the disease was caused by an advanced form of oncology, the prognosis is extremely poor.

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Diseases with similar symptoms:

As you know, the respiratory function of the body is one of the main functions of the normal life of the body. A syndrome in which the balance of blood components is disturbed, or, to be more precise, the concentration of carbon dioxide is greatly increased and the volume of oxygen decreases, is called "acute respiratory failure", it can turn into a chronic form. How the patient feels in this case, what symptoms may bother him, what signs and causes of this syndrome - read below. Also from our article you will learn about diagnostic methods and the most modern ways treating this disease.

Superior vena cava syndrome (SVCV) or cava syndrome is a whole complex of symptoms that arise as a result of impaired blood flow in the basin of the vessel of the same name. Due to circulatory disorders in this area, it is difficult for blood to drain from the venous vessels in the upper parts of the body. This pathology is manifested by blue discoloration skin, mucous membranes, saphenous veins, shortness of breath, hoarseness, cough, etc. You can recognize the patient by the flabby head, neck, arms, upper half of the torso.

SVPV is a serious pathology that threatens the patient's life. If the integrity of the vein wall is damaged, an acute violation of blood flow occurs. When the pressure in the vessel rises to 250 mm Hg / st, you cannot do without medical care otherwise the patient will die. That is why it is so important to detect in time characteristic symptoms and transport the patient to medical institution.

Kava Syndrome Basics

To better understand what is superior vena cava syndrome, you need to delve deeper into the anatomy of the chest. Upper vena cava(SVC) is an important blood vessel located in the middle mediastinum, and around it is the chest wall, trachea, bronchi, aorta, and lymph nodes. The SVC draws blood from the head, neck, arms, and upper body. This vessel has low pressure, and this is quite normal phenomenon... It is for this reason that any pathology of nearby tissues can damage the thin wall of the venous vessel and seriously disrupt blood flow.

Thanks to the anastomoses system (the junction of two blood vessels), the body independently copes with the violation of the patency of the SVC. But when the pressure rises to 250 mm Hg / st, then a crisis sets in. This is a very dangerous condition, so the patient needs urgent health care, otherwise death is inevitable.

SVCS is a secondary disease that complicates many pathologies associated with damage to the organs of the chest cavity. The pathology is based on compression or SVC, as a result of which the outflow of blood through the veins from the head, neck, arms and organs of the upper half of the torso is disturbed. Such a violation threatens with dangerous complications. Men from 30 to 60 years old are at risk.

The superior vena cava is located in the middle mediastinum, next to the aorta, trachea and bronchi

The reasons

To understand how the superior vena cava syndrome occurs, you need to know how it functions. Upper and lower vein flow into the right atrium. During the relaxation of the atrium, oxygen-poor blood is pumped into it. From there, it is fed into the right ventricle, and then into pulmonary artery, and in the lungs the venous blood is saturated with oxygen. Then arterial (oxygenated) blood returns through 4 pulmonary venous vessels to the left atrium, from where it goes to the left ventricle, then to the aorta and to all organs.

The inferior vena cava takes used blood from the organs below the diaphragm, and the SVC from the organs above the diaphragm. The basins of these vessels are clearly separated, but there are fistulas between them. With SVC stenosis, excess blood is discharged through the fistulas into the inferior vena cava.

Superior vena cava syndrome is provoked by malignant formations and thrombosis

The walls of the SVC are very thin, so the blood from the head moves almost under the influence of gravity. The muscles of the upper extremities help to speed up its movement. Near the SVC is a powerful aorta, a strong trachea and bronchi, a large number of lymph nodes. With the development of metastases in these anatomical structures, the SVC collapses and can no longer cope with its function.

Malignant formations in the lymph nodes deform them, which is why a section of the vein is compressed. With tumor lesion of the mediastinum due to cancer lymphatic system or the lung is impaired by the patency of the SVC. In addition to a tumor, there is a likelihood of vascular thrombosis due to tumor lesions. digestive tract or ovaries. Thus, venous stasis is provoked by tumors, metastases, blood clots.

Symptoms

Symptoms of the superior vena cava syndrome are caused by impaired venous blood flow in the SVC system. On the clinical picture affects the rate of development of cava syndrome, as well as the degree of impaired blood flow. Depending on these indicators, SVCS can develop slowly (when the vessel is squeezed or invaded) or quickly (when the SVC is blocked by blood clots).

The patient's upper body swells, the skin of the face and neck turns blue

The SVCS clinic includes swelling of the face, neck, arms, upper half of the torso due to the expansion of superficial venous vessels, as well as blue discoloration of the skin and mucous membranes. In addition, patients complain of shortness of breath, feeling short of breath, hoarseness, difficulty swallowing, coughing fits, and chest pain. Strengthening of these signs is observed when the patient takes a horizontal position, so they are forced to be in a semi-sitting position. Due to edema of the larynx, stridor appears (wheezing noisy breathing, rough and hoarse voice).

Often, SVCS is accompanied by nasal, pulmonary, gastric, and intestinal hemorrhages due to increased venous pressure and rupture of thinned vessels. Impaired venous outflow from the skull provokes headache, noises, drowsiness, convulsions, fainting. The functionality of the oculomotor or auditory nerves, double vision develops, protrusion eyeballs, excessive production of lacrimal fluid, various hearing disorders.

Diagnostic measures

Physical diagnostics can help identify the characteristic symptoms of SVCS. As a result of a visual examination, the doctor can easily determine the expansion of the veins in the neck and chest, blue face, swelling of the upper torso. If SVPV is suspected, a chest x-ray is prescribed in two projections. If necessary, perform computed, magnetic resonance imaging. To identify the location and severity of SVC obstruction, phlebography is prescribed.

If SVPV is suspected, an x-ray is prescribed

To diagnose blockage by a thrombus of a venous vessel or its squeezing from the outside, carry out ultrasound doppler carotid and supraclavicular veins.

The ophthalmologist will identify eye disorders specific to SVPV:

• convoluted and dilated veins of the fundus;
• swelling of the peripapillary area;
• non-inflammatory edema optic nerve;
• increased pressure of intraocular fluid.

To determine the causes of SVPV and confirm the morphological (tumor genesis) diagnosis, bronchoscopy is performed with tissue sampling, as well as bronchial sputum, which are examined for the presence of atypical cells. Also carry out microscopic studies of rinsing water from the deep sections of the bronchial tree. In addition, lymph node cells are collected and sternal puncture is performed.

If necessary, the doctor prescribes additional studies:

• video thoracoscopy;
• mediastinoscopy;
• mediastinotomy, etc.

Differential diagnosis of SVPV is carried out with functional heart failure. With the pathology of the superior vena cava, there is no peripheral edema, accumulation of transudate (non-inflammatory fluid) in pleural cavity, abdominal dropsy.

Treatment methods

Symptomatic treatment pathology is carried out in order to increase the functional reserves of the body. The patient should follow a low-salt diet, he is prescribed oxygen inhalations, diuretics and glucocorticoid drugs. After the doctor establishes the causes of the development of SVCS, pathogenetic treatment is carried out.

If the disease is provoked by lung cancer, lymphoma (cancer of the lymphatic tissues), Hodzhikin's disease, metastases, chemotherapy and radiation therapy are prescribed. If SVCS is caused by blockage of the superior vena cava by blood clots, then thrombolytic treatment is performed, an operation to remove the clot. And sometimes it is necessary to remove a section of the vein, which is replaced with a homograft.

Treat SVCS symptoms to treat primary disease

With extravasal compression of the superior vena cava, surgical intervention is also indispensable. The surgeon can remove a tumor or cyst in the mediastinum, mediastinal lymphoma, etc. If for some reason surgical intervention is contraindicated, then palliative surgery is prescribed, which improves venous outflow.

The prognosis of SVC syndrome depends on the primary disease and the possibility of surgery. After eliminating the main causes, the signs of superior vena cava syndrome disappear. In the acute course of cava syndrome, the likelihood of rapid death of the patient increases. If SVPV is caused by advanced cancer, then the prognosis is poor. That is why it is important to identify the pathology in time and carry out its treatment.

Angiosarcoma is a malignant formation. Vascular cancer is rather rare in comparison with other oncological diseases - about 3% of all diseases of this type. The disease is characterized by rapid development, rapid transition of metastases and their development. Vascular cancer is difficult to treat, the prognosis is disappointing, especially if the disease is not on initial stage.

What it is

Vascular cancer is angiosarcoma, malignant neoplasms, which very quickly begin to metastasize. They are located on the inner side of the vascular wall. It develops with the same frequency in men and women. Cancers most often occur on the skin, liver, mammary glands, brain, and spleen.

The causes of the occurrence are not fully understood, it is this factor that largely explains the impossibility of treatment with traditional types of therapy. The causes of development are considered to be the effect on the body of arsenic, thorium dioxide, ionizing radiation. Chronic lymphodema and mutational processes are also called as the cause of the tumor.

The main distinctive feature vascular cancer is that the disease develops rapidly. Metastasis occurs instantly, in most cases, when the patient begins to notice the symptoms, the disease is at an advanced stage, therefore, cannot be treated.

Vein tumors are vascular cancers characterized by impaired blood flow in the veins. In addition to the main factors, blood clots in the vessels lead to this, as well as varicose veins.

Vein cancer is diagnosed independently only if the formation is located on the subcutaneous layer of the epithelium. In this case, you may notice a purple spot on the skin. But in most cases, vessels that are not on the surface itself are affected.

The impossibility of self-diagnosis, the late manifestation of symptoms (only when the nerve fibers are squeezed) make vein cancer a serious oncological disease that is practically not amenable to treatment.

Arterial cancer is a tumor on carotid artery... It does not develop so quickly, it is often benign, but also often and suddenly begins to metastasize. It manifests itself only in a neglected state, then the symptomatology is expressed in the sensation of a pulsating mass on the neck.

Classification

The malignant neoplasm has a dense texture with an uneven outline, and is filled with voids with blood inside. The formations are permeated with small vessels and capillaries, while they can affect any part of the human body.

The disease is classified not only by how quickly it spreads in the body, but also by its location and the areas of the body that are primarily affected.

Allocate:

• vascular cancer general;
• vascular cancer heads;
• breast cancer;
• cancer resulting from beam irradiation;
• hemangioendothelioma.

Vascular cancer is common and presents as small nodules, bluish-purple in color, which can spread to any part of the skin. It is usually found on the legs, thighs, chest, arms.

Over time, small nodules merge into a knot. The usual cause of this type of cancer is a malfunction of the lymphatic flow.

Cancer of the vessels of the head, idiopathic angiosarcoma, is characterized by the appearance of small seals and nodules, which also eventually merge into a node. Such cancer very quickly begins to metastasize, the prognosis in most cases is negative.

It can affect both the area on which the hairline is present, and the larynx, her, pharynx, tonsils. Basically, head vascular cancer affects men (twice more often than women) aged 65 and over.

Breast cancer appears as small nodules that can be pink, red, burgundy, or blue in color. In this case, the nodes are painful.

Within a few months, they transform into a tumor, which is removed surgically. Breast cancer, which is essentially a vascular cancer, affects women between 35 and 45 years of age.

Cancer resulting from radiation is called radiation cancer. Angiosarcoma rapidly spreads throughout the body, metastasizes instantly.

In its manifestations, it is like a common vascular cancer, that is, the seals are small, not causing discomfort. Localized on the chest, thighs and abdomen.

Hemangioendothelioma is a tumor made up of endothelial cells. The origin of the disease is practically not studied, it is extremely difficult to treat it.

The reasons

The causes of the appearance of malignant formations on the walls of blood vessels are not fully understood. However, the most common are:

• irradiation, including those that were used as therapy in the treatment of other oncological diseases;
• mechanical trauma;
• mutation benign tumor.

It should be noted that angiosarcoma can manifest itself as a result of training after several years. It can also form if a person regularly states with substances that can emit polyvinyl chloride, arsenic.

Among other factors, vascular cancer can lead to dysfunction of immune functions, vascular diseases, including varicose veins, hemochromatosis.

Symptoms

The appearance of vascular cancer initially looks like small lumps, usually purple or bluish in color. Nevertheless, they can be of a different color, especially if they are located on the mammary glands - red, pink or blue. After a certain period (each patient has a different term), these small seals merge and form a single round ball of pronounced purple color.

Other signs of vascular cancer development:

• dysfunction liver;
• general weakness organism;
• manifestation swelling;
• anemia;
• sharp jumps temperature;
• unconditional decline weight;
• nausea and vomiting;
• manifestation ulcerative disease.

Symptoms on the list are not associated with vascular cancer alone. It also occurs with the development of other diseases, not necessarily associated with cancer. Only a specialist after an examination can make an accurate diagnosis and prescribe a treatment plan.

Diagnostics

Determination and diagnosis takes place in several stages. After the anamnesis, an examination is prescribed, during which the oncologist determines the size of the neoplasm, its consistency. Palpation is required.

If there is a suspicion of cancer, then further diagnostic measures are carried out as follows:

• x-ray examination (degree of spread of metastases);
• MRI and CT (allow you to find out about the condition of the tissues);
• biopsy(taking for analysis a small piece tumors);
• Ultrasound;
• angiography(X-ray is performed in this way);
• taking tests blood;
• identification of oncological markers.

The main method is biopsy. It is with the help of clinical research a tissue sample confirms or refutes the diagnosis. Other methods help to determine the state of the blood, the spread of metastases.

Treatment

The initial stage, that is, the location of the tumor on the surface, in most cases is successfully treated. In this case, the tumor, if no metastases have appeared, expire and suture. If the tumor is not located on the surface, then surgical method removal of the entire limb is possible.

Surgical intervention is carried out modern techniques... With the help of computer technology, the optimal angle of amputation and the force of impact are calculated.

After surgery, the patient is indicated for radiation and chemotherapy. They reduce the risk of recurrence after surgery.

Detection of a neoplasm at the initial stage has a positive prognosis. At the same time, the picture worsens if the tumor has invaded the lymph node, metastases have appeared, the location on mammary glands and head.

After removal of the tumor, the patient is registered with an oncologist. In the first two years, a visit to the doctor is prescribed once a quarter, after this period - once every six months.

During the examination, the specialist examines the skin of the lymph nodes, veins for the presence of an incipient disease (detects if there are nodules, tumors). If necessary, palpation of the lymph nodes is performed. Also, the patient undergoes X-ray and tests. A biopsy is not required at this stage.

A detailed examination after surgery is necessary in order to timely identify the spread of metastases, recurrence of vascular cancer and prevent it.

Complications

Complications relate primarily to the recurrence and spread of metastases. Cancer tumor, even if the limb is completely removed, it may appear again. There is also a risk that the remaining metastases will spread even faster.

Forecast

The prognosis for patients with vascular cancer is disappointing. Even a timely operation does not provide guarantees. Interventions are successful in 70% of cases, but as a result of recurrence from vascular cancer, patients die within two years. Less than 10% of those who underwent surgery manage to survive five years or more after it.

Prophylaxis

There are no measures to prevent the development of the disease. But since the cause of cancer is contact with chemicals, radiation exposure, one can understand that the prevention of pathology will be their exclusion.

Vascular cancer is difficult to treat, the prognosis is disappointing. Even with a successful operation, the disease requires careful attention. At the slightest suspicion of a relapse, you should immediately contact an oncologist.

Not everyone knows what it is, and many have not heard until the moment when problems appear. Compression syndrome of the superior vena cava is a collection of symptoms that are caused by compression or partial blockage of the vein that carries blood flow from the head and neck to upper part torso, arms and heart (its abbreviated name is SVCS). Most often, and this is in 95% of cases, it is caused by cancer.

Symptoms

This ailment develops not only due to compression of the vein, but also because a blood clot arises in it, which impedes the outflow of blood from the head and chest.
A person develops the following symptoms:

• Constantly sleepy.
• Headache attacks.
• Swelling on the face, neck, and chest.
• Chest pain.
• The face is purple-blue.
• Difficulty breathing.
• The throat is swollen.
• Pulmonary edema.
• The state of health is close to fainting.
• Whistling is heard during breathing.
• Cough.
• Dilation of superficial veins.
• The skin on the chest and arms becomes bluish in color.
• Convulsions.

These signs are main, but there are also secondary ones:

• Hearing and vision are impaired.
• Auditory hallucinations.
• Eyes tear.

Symptoms are more pronounced at the moment of bending forward, as well as when raising the arms up.

The brightness of the expression of symptoms directly depends on the rate of progression of the disease. The stronger the compression, the more the collateral circulation is disturbed, and it is the main source of oxygen supplied to the organs. The main factor causing this condition is lung cancer. Signs of compression become, clearly visible through a short time, only 3-4 weeks. In this case, blood pressure rises to 200-500 mm, water. Art.

It's important to know. Men between the ages of 30 and 60 are much more likely to experience this pathology than women.

Causes of SVCS

There are many of them, but experts identify some of the most basic ones:

• The external nature of the vein compression.
• Thrombus.
• Compressive pericarditis.
• Lung cancer.
• Melanoma.
• Lymph node cancer (lymphoma).
• Silicosis.
• Tumor of organs located in the area of ​​the diaphragm.
• Sarcoma.
• Infection with tuberculosis.
• Mediastinal teratoma.
• Breast oncology.
• Cardiovascular diseases.
• Overgrowth of fibrous tissue.

It happens that human body itself causes similar changes, reacting in this way to surgery or long-term use venous catheter.

Diagnostic methods

Before starting the procedures, the doctor must find out the medical history and find out the reasons for the development of the syndrome.

It is diagnosed as follows:

• A chest x-ray is taken. Pictures are taken in different projections.
• Mandatory tomography - spiral, MRI and CT.
• Phlebography - performed in order to identify the location of the localization of the disease.
• Doppler ultrasound ultrasonography is performed.
• The patient undergoes bronchoscopy together with a biopsy - it identifies the factors due to which the disease has formed.
• The sputum is examined in the laboratory.

If necessary, the specialist conducting the study prescribes thoracoscopy and mediastinoscopy, as well as referring the patient to an ophthalmologist for a consultation, he will measure the intraocular pressure. In addition, you need to distinguish between pathology and heart failure. After the doctor receives all the tests, he will be able to determine exactly the direction of therapy that is required for this particular patient.

How is the disease treated?

Therapy is selected based on the rate at which the disease and symptoms develop.
In more than 50% of cases, the syndrome begins to develop before the patient is diagnosed. For the doctor to be able to conduct effective therapy, he needs to determine the original process that became the cause.

In the case when the disease is difficult, and there is a threat to the patient's life, therapy begins urgently, without making the main diagnosis. The main goal is to stop the signs of the disease. In half of all cases, SVCS is treatable.

Basic methods

Medication

Drug therapy is very effective in treating compression syndrome. For this, anticoagulants or fibrinolytic drugs are used. medical drugs... These funds are prescribed only if thrombosis is detected, during phlebography, or when the effectiveness of the measures used is too low.

Surgical

Among the methods of treating thrombosis of the superior vena cava, from malignant formation with surgery, the most effective is: percutaneous endovascular balloon angioplasty, together with the installation of a stent in the place where the venous lumen narrows. To get the maximum effect from the treatment, it must be started at early stage ailment.

Recommendations for pregnant women with compression of the inferior vena cava syndrome

The inferior vena cava is located along the length of the spine, has a large diameter, and through it venous blood is withdrawn from internal organs and legs. When the uterus is enlarged, it is compressed. As a result, the outflow of blood to the heart is reduced, and it circulates in smaller volumes through the lungs.

Doctors recommend to expectant mothers:

• Sleep on the left side.
• Place pillows made for pregnant women under your back.
• Walking more often will improve venous return.
• Exercise in the pool, water helps to squeeze blood out of the legs.

Pregnant women with this syndrome sleep on their backs and do physical exercises, you can't.

No matter how dire the symptoms may seem, it must be remembered that, despite the complexity, SVCS can be treated. Well, if we take into account that today the XXI century and technologies in medicine continue to develop, then this is not a sentence. In order to somehow protect yourself, it will be useful to undergo an annual survey.

Is a symptom complex that develops as a result of circulatory disorders in the superior vena cava system and difficulty in the outflow of venous blood from upper divisions torso. The classic signs of the superior vena cava syndrome are: cyanosis; puffiness of the head, neck, upper extremities, upper half of the chest; expansion of the saphenous veins; shortness of breath, hoarseness, cough, etc. Often, cerebral, ocular, hemorrhagic manifestations develop. The diagnostic algorithm may include chest radiography, venocavography, chest CT and MRI, ultrasound scan, mediastinoscopy, thoracoscopy with biopsy. With the syndrome, endovascular balloon angioplasty and stenting, thrombectomy, SVC resection, bypass grafting, palliative tumor removal in order to decompress the mediastinum can be undertaken.

General information

Superior vena cava syndrome (SVCS), or cava syndrome, is understood as secondary pathological condition complicating many diseases associated with damage to the mediastinal organs. Cava syndrome is based on extravasal compression or thrombosis of the superior vena cava, which disrupt the outflow of venous blood from the head, shoulder girdle and upper half of the body, which can lead to life-threatening complications. Superior vena cava syndrome is 3-4 times more likely to develop in male patients aged 30-60 years. In clinical practice, specialists in the field of thoracic surgery and pulmonology, oncology, cardiac surgery, phlebology have to deal with the superior vena cava syndrome.

The superior vena cava (SVC) is located in the middle mediastinum. It is a thin-walled vessel surrounded by dense structures - the chest wall, aorta, trachea, bronchi, a chain of lymph nodes. Features of the structure and topography of the SVC, as well as physiologically low venous pressure, cause a slight occurrence of obstruction of the main vessel. Through the SVC, blood flows from the head, neck, upper shoulder girdle and upper chest. The superior vena cava has a system of anastomoses that perform a compensatory function in violation of the patency of the SVC. However, venous collaterals cannot completely replace SVC. With superior vena cava syndrome, the pressure in its basin can reach 200-500 mm of water. Art.

Causes of SVPV

The following pathological processes can contribute to the development of the superior vena cava syndrome: extravasal SVC compression, tumor invasion of the SVC wall, or thrombosis. In 80-90% of cases, the direct causes of cava syndrome are lung cancer, mainly right-sided localization (small cell, squamous cell, adenocarcinoma); lymphogranulomatosis, lymphomas; metastases of breast cancer, prostate cancer and testicular cancer in the mediastinum; sarcoma, etc.

In other cases, SVC compression can be caused by benign tumors of the mediastinum (cysts, thymomas), fibrous mediastinitis, aortic aneurysm, constrictive pericarditis, infectious lesions: (syphilis, tuberculosis, histoplasmosis), retrosternal goiter. Superior vena cava syndrome can be caused by SVC thrombosis, which develops against the background of prolonged catheterization of the vein with a central venous catheter or the presence of pacemaker electrodes in it.

SVPV symptoms

The clinical manifestations of superior vena cava syndrome are caused by an increase in venous pressure in the vessels, from which blood normally flows through the SVC or unnamed veins. The severity of manifestations is influenced by the rate of development of the superior vena cava syndrome, the level and degree of circulatory disorders, the adequacy of collateral venous outflow... Depending on this clinical course superior vena cava syndrome can be slowly progressive (with SVC compression and invasion) or acute (with SVC thrombosis).

The classic triad characterizing superior vena cava syndrome includes edema, cyanosis, and enlargement of superficial veins in the face, neck, upper extremities, and upper torso. Patients may be disturbed by dyspnea at rest, asthma attacks, hoarseness, dysphagia, cough, chest pain. These symptoms are aggravated in the supine position, so patients are forced to take a half-sitting position in bed. In a third of cases, there is a stridor caused by laryngeal edema and threatening obstruction respiratory tract.

Complications

Often, with superior vena cava syndrome, nasal, pulmonary, and esophageal bleeding develops, caused by venous hypertension and rupture of thinned vessel walls.

Violation of venous outflow from the cranial cavity leads to the development of cerebral symptoms:

• headache
• noise in the head
• sleepiness
• confusion and loss of consciousness.

Due to dysfunction of the oculomotor and auditory nerves, the following may develop:

• diplopia
• bilateral exophthalmos
• lacrimation
• eye fatigue
• decreased visual acuity
• auditory hallucinations

Diagnostics

Physical examination of a patient with superior vena cava syndrome reveals swelling of the neck veins, an enlarged network of subcutaneous venous vessels on the chest, plethora or cyanosis of the face, and edema of the upper half of the trunk. If the superior vena cava syndrome is suspected, all patients are shown an x-ray examination - chest x-ray in two projections, tomography (computed, spiral, magnetic resonance imaging). In some cases, phlebography (venocavagraphy) is used to determine the localization and severity of venous obstruction.

CT scan of the chest. A sharp narrowing of the lumen of the superior vena cava due to the growth of a mediastinal tumor into it with severe obstruction of the outflow of venous blood from the head and upper extremities

With the aim of differential diagnosis SVC thrombosis and external obstruction is indicated by USDG of the carotid and supraclavicular veins. Examination of the fundus by an ophthalmologist reveals tortuosity and dilatation of the retinal veins, edema of the peripapillary region, and stagnant optic nerve head. When measuring intraocular pressure, a significant increase can be noted.

To determine the causes of the superior vena cava syndrome and to verify the morphological diagnosis, it may be necessary to conduct bronchoscopy with biopsy and sputum sampling; analysis of sputum for atypical cells, cytological examination of washing water from the bronchi, biopsy lymph node(prescaled biopsy), sternal puncture with myelogram examination. If necessary, diagnostic thoracoscopy, mediastinoscopy, mediastinotomy, or parasternal thoracotomy may be performed for revision and biopsy of the mediastinum.

Differential diagnosis of cava syndrome is carried out with congestive heart failure: with superior vena cava syndrome, there are no peripheral edema, hydrothorax, ascites.

SVPV treatment

Symptomatic treatment of superior vena cava syndrome is aimed at increasing the functional reserves of the body. It includes the appointment of a low-salt diet, oxygen inhalation, diuretics, glucocorticoids. After establishing the cause that caused the development of the superior vena cava syndrome, pathogenetic treatment is applied.

So, with the superior vena cava syndrome caused by lung cancer, lymphoma, lymphogranulomatosis, metastases of tumors of other localizations, polychemotherapy and radiation therapy are performed. If the development of superior vena cava syndrome is caused by SVC thrombosis, thrombolytic therapy is prescribed, thrombectomy is performed, in some cases - resection of the superior vena cava segment with replacement of the resected area with a venous homograft.

With extravasal SVC compression, radical interventions may include extended removal of a mediastinal tumor, removal of mediastinal lymphoma, thoracoscopic removal of a benign mediastinal tumor, removal of a mediastinal cyst, etc. radical surgery resort to various palliative surgical interventions, aimed at improving venous outflow: removal of the mediastinal tumor for decompression, bypass bypass, percutaneous endovascular balloon angioplasty and stenting of the superior vena cava.

Forecast

Long-term results of treatment of superior vena cava syndrome depend, first of all, on the underlying disease and the possibilities of its radical treatment. Elimination of the causes leads to the relief of the manifestations of the cava syndrome. The acute course of the superior vena cava syndrome can cause rapid death of the patient. With superior vena cava syndrome caused by a neglected oncological process, the prognosis is poor.