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Superior Vena Cava Syndrome Developing in Non-small Cell Lung Cancer
March 2014, Vol 145, No. 3_MeetingAbstracts Lung Cancer | March 2014
Superior Vena Cava Syndrome Developing in Non-small Cell Lung Cancer Anita Rajagopal, MD; Jon Simala, MD Department of Internal Medicine, St Vincent Medical Center, Indianapolis, IN
Chest. 2014;145(3_MeetingAbstracts):299A. doi:10.1378/chest.1723701
Abstract SESSION TITLE: Cancer Case Report Posters I SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM INTRODUCTION: First described in 1757 [1], Superior vena cava syndrome (SVCS) is an array of symptoms caused by the impairment of blood flow through the SVC to the right atrium. Symptoms include dyspnea, coughing, and swelling of the face, neck, upper trunk, and extremities [2]. Most commonly seen in small cell lung cancer, only a small percentage of non small cell lung cancer (NSCLC) patients, 1%, develop the syndrome. CASE PRESENTATION: A 78-year-old male, with locally advanced NSCLC of the right lung, was being set up for systemic chemotherapy. He presented to the emergency department with dyspnea, orthopnea, blurred vision, hoarseness, facial swelling, right lid droop, and facial plethora over a week. He was in moderate respiratory distress. His O2 sat was 95% on 100% O2 via non re-breather mask. Chest exam revealed decreased breath sounds bilaterally but clear. CTA chest was negative for emboli but significant for increase in the size of a mediastinal mass with evidence of superior vena caval obstruction (figure 1,2). Clinically, he had evidence of SVC obstruction with upper extremity edema, facial edema, increased collateral veins in his neck, anterior and posterior chest. He was admitted to ICU and started on IV methylprednisolone 125mg with diuretics. Radiation oncology performed decompressive external beam radiation repeated for a total of 900 cGy in 3 fractions. The patients O2 requirements decreased to 6l O2 via nasal cannula. His dyspnea markedly improved.
DISCUSSION: SVCS occurs in approximately 15,000 persons in the United States each year [3]. While in the past causes were primarily infectious, they are now predominantly malignant causes. In a 2006 study, 78 patients with SVCS were studied over 5 years. Malignancy was the etiology in 60% of the cases, and bronchogenic carcinoma was the most common. Small cell and NSCLC accounted for 17 (22%) and 19 (24%) cases, respectively, but a higher percentage of patients with small-cell lung cancer developed the syndrome (6% vs 1%) [2]. We present a case of a patient with NSCLC who developed SCVS, successfully treated with radiation. CONCLUSIONS: This case illustrates that given the rarity of the number of patients with NSCLC who develop SVCS, prompt recognition and treatment is vital in leading to successful improvement in symptoms and reduction in O2 requirements. Reference #1: Hunter, W. The history of an aneurysm of the aorta with some remarks on aneurysms in general. Med ObsSoc Phys Lond. 1757:323 Reference #2: Rice TW et al. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine 2006,85:37-42 Reference #3: Higdon ML et al. Treatment of oncologic emergencies. Am Fam Physician. 2006,74:1873-80 DISCLOSURE: The following authors have nothing to disclose: Anita Rajagopal, Jon Simala No Product/Research Disclosure Information
Superior Vena Cava Syndrome Developing in Non-small Cell Lung Cancer Anita Rajagopal, MD; Jon Simala, MD Department of Internal Medicine, St Vincent Medical Center, Indianapolis, IN
Chest. 2014;145(3_MeetingAbstracts):299A. doi:10.1378/chest.1723701
Abstract SESSION TITLE: Cancer Case Report Posters I SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM INTRODUCTION: First described in 1757 [1], Superior vena cava syndrome (SVCS) is an array of symptoms caused by the impairment of blood flow through the SVC to the right atrium. Symptoms include dyspnea, coughing, and swelling of the face, neck, upper trunk, and extremities [2]. Most commonly seen in small cell lung cancer, only a small percentage of non small cell lung cancer (NSCLC) patients, 1%, develop the syndrome. CASE PRESENTATION: A 78-year-old male, with locally advanced NSCLC of the right lung, was being set up for systemic chemotherapy. He presented to the emergency department with dyspnea, orthopnea, blurred vision, hoarseness, facial swelling, right lid droop, and facial plethora over a week. He was in moderate respiratory distress. His O2 sat was 95% on 100% O2 via non re-breather mask. Chest exam revealed decreased breath sounds bilaterally but clear. CTA chest was negative for emboli but significant for increase in the size of a mediastinal mass with evidence of superior vena caval obstruction (figure 1,2). Clinically, he had evidence of SVC obstruction with upper extremity edema, facial edema, increased collateral veins in his neck, anterior and posterior chest. He was admitted to ICU and started on IV methylprednisolone 125mg with diuretics. Radiation oncology performed decompressive external beam radiation repeated for a total of 900 cGy in 3 fractions. The patients O2 requirements decreased to 6l O2 via nasal cannula. His dyspnea markedly improved.
DISCUSSION: SVCS occurs in approximately 15,000 persons in the United States each year [3]. While in the past causes were primarily infectious, they are now predominantly malignant causes. In a 2006 study, 78 patients with SVCS were studied over 5 years. Malignancy was the etiology in 60% of the cases, and bronchogenic carcinoma was the most common. Small cell and NSCLC accounted for 17 (22%) and 19 (24%) cases, respectively, but a higher percentage of patients with small-cell lung cancer developed the syndrome (6% vs 1%) [2]. We present a case of a patient with NSCLC who developed SCVS, successfully treated with radiation. CONCLUSIONS: This case illustrates that given the rarity of the number of patients with NSCLC who develop SVCS, prompt recognition and treatment is vital in leading to successful improvement in symptoms and reduction in O2 requirements. Reference #1: Hunter, W. The history of an aneurysm of the aorta with some remarks on aneurysms in general. Med ObsSoc Phys Lond. 1757:323 Reference #2: Rice TW et al. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine 2006,85:37-42 Reference #3: Higdon ML et al. Treatment of oncologic emergencies. Am Fam Physician. 2006,74:1873-80 DISCLOSURE: The following authors have nothing to disclose: Anita Rajagopal, Jon Simala No Product/Research Disclosure Information