Picture this:
A patient is found unconscious at home, and you find this π on your evaluation.
Why (and how) is this an emergency? π€
𧡠1/8
A patient is found unconscious at home, and you find this π on your evaluation.
Why (and how) is this an emergency? π€
𧡠1/8
To guide our thoughts, here are 2 superior vena cava (SVC) syndrome facts-
1) Principle of physics:
π For a fixed flow, volume is inversely related to pressure
2) SVC obstruction (β¬οΈ volume), causes edema (β¬οΈ pressure) of brain π§ & larynx π«
𧡠2/8
1) Principle of physics:
π For a fixed flow, volume is inversely related to pressure
2) SVC obstruction (β¬οΈ volume), causes edema (β¬οΈ pressure) of brain π§ & larynx π«
𧡠2/8
The 2 most common malignant causes of SVC syndrome are:
1οΈβ£ Lung cancer (~50%)
and 2οΈβ£ lymphomas (~10%)
Lymphomas can have a MUCH faster rate of growth π
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1οΈβ£ Lung cancer (~50%)
and 2οΈβ£ lymphomas (~10%)
Lymphomas can have a MUCH faster rate of growth π
𧡠3/8
With life-threatening edema in mindβ¦
Why do fast-growing lymphomas cause more severe symptoms than slow-growing lung cancer? π€
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Why do fast-growing lymphomas cause more severe symptoms than slow-growing lung cancer? π€
𧡠4/8
π Collateral veins can bypass the SVC *but formation takes weeks*
These drain to 1οΈβ£ internal thoracic
then 2οΈβ£ superior epigastric
and finally 3οΈβ£ left portal vein
and you can see this flow through the portal vein on CTπ
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These drain to 1οΈβ£ internal thoracic
then 2οΈβ£ superior epigastric
and finally 3οΈβ£ left portal vein
and you can see this flow through the portal vein on CTπ
𧡠5/8
For treatment, the most important step is triage
Life-threatening symptoms? π! Here are 2 fast-acting treatments-
1οΈβ£ π Steroids can rapidly relieve obstruction from lymphoma
2οΈβ£ Stents can relieve pressure FAST π
𧡠6/8
Life-threatening symptoms? π! Here are 2 fast-acting treatments-
1οΈβ£ π Steroids can rapidly relieve obstruction from lymphoma
2οΈβ£ Stents can relieve pressure FAST π
𧡠6/8
No life-threatening symptoms?
π Lymphomas & small cell lung cancer are sensitive to chemo and radiation
π© Lung adenocarcinoma is slower to respond- consider a palliative stent
𧡠7/8
π Lymphomas & small cell lung cancer are sensitive to chemo and radiation
π© Lung adenocarcinoma is slower to respond- consider a palliative stent
𧡠7/8
Key takeaways:
π Occlusion of SVC β¬οΈ volume and β¬οΈ upper body pressure
π Lymphomas can grow (& respond) faster than lung cancer
π Treatment depends on symptoms (π§ & π«) and tumor sensitivity
𧡠8/end
π Occlusion of SVC β¬οΈ volume and β¬οΈ upper body pressure
π Lymphomas can grow (& respond) faster than lung cancer
π Treatment depends on symptoms (π§ & π«) and tumor sensitivity
𧡠8/end
Thanks for sticking around- I hope we all learned something new!
Thank you to @lymphomatic and Andrew Hsu for the peer review π
I would love to hear what other experts would add! @majorajay @OllilaTom @haematognomist @BldCancerDoc @GomezDLeonMD @EM_RESUS @nickmmark @jtrebach
Thank you to @lymphomatic and Andrew Hsu for the peer review π
I would love to hear what other experts would add! @majorajay @OllilaTom @haematognomist @BldCancerDoc @GomezDLeonMD @EM_RESUS @nickmmark @jtrebach
Full articles here-
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
Images from (and adapted for this case)-
nejm.org
imagebank.hematology.org
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
Images from (and adapted for this case)-
nejm.org
imagebank.hematology.org
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