Superior Vena Cava Syndrome
Presentation:
J.C. is a 30 year old man. He was brought to the emergency room by his fiancé after complaining of increased shortness of breath and marked edema in his upper extremities and face. He has no known allergies. His past medical history included a mediastinal germ cell tumor diagnosed three months ago and seasonal allergies. J.C. recently received cisplatin, bleomycin, and etoposide as treatment for his germ cell tumor. In the emergency room, J.C.’s vital signs were BP: 146/88, HR:104, RR: 26, Temp: 37.1, Pulse Oximetry: 89% on room air. He complained of difficulty catching his breath and a non-productive cough worsening over the past few hours. J.C.’s physical exam revealed 2-3 plus non-pitting edema in bilateral upper extremities and marked facial edema. No edema was present in his abdomen or lower extremities. He had significant facial flushing and jugular venous distention.
Differential list:
Superior vena cava syndrome, cardiotoxicity caused by bleomycin, right-sided heart failure, mediastinitis, and pulmonary embolism
Diagnosis:
A CT scan revealed that the patient’s large, lobulated right chest wall mass had increased in size and was now compressing his superior vena cava.
A 2d echocardiogram revealed no evidence of any cardiac damage from bleomycin. J.C.’s ejection fraction was 62%.
Treatment:
J.C. was admitted to a medical oncology unit. The radiation oncology service was consulted and recommended urgently starting a six week course of chest radiation to shrink the size of the tumor and alleviate pressure on the superior vena cava. J.C. received supplemental oxygen via a nasal cannula and received Medrol® 1 gm intravenously every 12 hours for several days. During his hospital stay, J.C. was evaluated by the interventional radiology service to determine whether a stent would be necessary to relieve pressure on his superior vena cava.
Outcome:
J.C.’s tumor responded well to radiation and his symptoms began to improve after a few treatments. His steroid dose was tapered and he was discharged from the hospital. He continued to improve and all of his symptoms resolved within a couple of weeks. He completed his course of radiation therapy and resumed his chemotherapy treatments for his germ cell cancer. He completed chemotherapy treatments approximately five months later. He has been in remission for three years.