Syndrome of an upper vena cava
Contents:
Description:
The Syndrome of an Upper Vena Cava (SUVC) - the medical emergency connected with disturbance of blood circulation in the pool of an upper vena cava which complicates the course of many diseases connected with defeat of a mediastinum. Recently increase in frequency of this state is connected with growth of cancer cases of a lung which is the main reason for SVPV.
Symptoms of the Syndrome of an upper vena cava:
Clinical picture SVPV is connected with increase in intravascular pressure in zones from which venous outflow is normal drained through an upper vena cava or the anonymous veins forming it. The delay of speed of a blood-groove, development of venous collaterals, symptoms connected with a basic disease are the SVPV components.
Expressiveness of various signs of SVPV depends on the speed of development of pathological process, level and degree of a prelum of a gleam of an upper vena cava and adequacy of collateral circulation.
The clinical current of SVPV can be acute or slowly progressing. Complaints of the patient are extremely various: a headache, nausea, dizziness, appearance change, a voice osiplost, cough, a dysphagy, thorax pains, the complicated breath, an asthma, drowsiness, faints, spasms.
At physical inspection the most characteristic signs of SVPV come to light: expansion, swelling of veins of a neck, chest wall and upper extremities, face edema, neck or upper shoulder girdle, cyanosis or plethora of the person (plethora), tachypnea.
Reasons of the Syndrome of an upper vena cava:
Development of SVPV is the cornerstone three main pathological processes:
* vein prelum from the outside,
* germination of a wall of a vein malignant tumor,
* thrombosis of an upper vena cava.
Proceeding from anatomo-physiological features of this area, the processes increasing the volume of fabrics of a mediastinum or leading to obstruction of a vein from within belong to the etiological reasons.
In the analysis of the reasons of development of a syndrome in different series it was shown that lung cancer is on the first place, at the same time the syndrome develops in 80% of cases at damage of the right lung.
The following belongs to malignant tumors most of which often (to 80-90%) are complicated by SVPV:
* lung cancer (right-hand is more often),
* nekhodzhkinsky lymphoma,
* metastatic forms of a breast cancer, germinogenny tumors, digestive tract,
* myagkotkanny sarcomas, especially malignant fibrous histiocytoma,
* melanoma.
It should be noted that SVPV meets at small-celled cancer of a lung more often, than at other morphological forms. The planocellular option of this disease is on the second place.
Less often SVPV meets at adenocarcinomas and other histologic forms of cancer of lung. SVPV arises preferential at diffusion macrocellular or lymphoblastoid forms of lymphoma with localization in a front mediastinum.
Among other reasons leading to SVPV it should be noted:
* infectious diseases: tuberculosis, syphilis, гистиоплазмоз,
* fibrinferments (traumatic, spontaneous or owing to secondary defeat of vessels of a mediastinum),
* iatrogenic reasons,
* idiopathic fibrous mediastinitis,
* cardiovascular insufficiency,
* retrosternal craw.
Treatment of the Syndrome of an upper vena cava:
Optimum treatment depends on the reasons which caused SVPV and speeds of development of symptoms of a progression. Almost in half of cases of SVPV develops before diagnosis. At the same time it is necessary to emphasize that definition of the initial process which caused this state is a key to successful therapy, and only in case of heavy disturbances and in a life-threatening state the initiation of treatment without establishment of the main diagnosis is admissible.
The purpose of medical actions at SVPV is stopping of pathological symptoms. However it is not a main objective of treatment of the patient. It is necessary to remember that more than 50% of cases of SVPV are caused by potentially curable diseases, such as small-celled cancer of a lung, nekhodzhkinsky lymphoma and germinogenny tumors.
It is interesting to note that existence of SVPV in some researches was an advantage predictive factor for small-celled cancer of a lung and adverse for not small-celled cancer of the same localization.
The emergency symptomatic actions are directed to rescue of life of the patient, they are necessary to provide intake of air in lungs, to liquidate impassability of an upper vena cava and a prelum of bodies of a mediastinum. Except rest, sublime situation, an oxygen therapy, the tracheostomy, an intubation, introduction of anticonvulsants can sometimes be required. Use of diuretics and corticosteroids is shown.
Radiation therapy by large fractions is a highly effective method of treatment of SVPV, especially at not small-celled cancer of a lung. Efficiency reaches it 70-90%.
Radiation of a thorax has to begin as soon as possible. Performing emergency radiation therapy is required at respiratory insufficiency (including stridorny breath) or in the presence of symptoms from TsNS.
It is more preferable to carry out chemotherapy as the first line in the presence of the tumors sensitive to cytostatics (limfoproliferativny diseases, a myeloma, germinogenny tumors, cancer of milk and prostatic glands).
The combination therapy (chemotherapy and radiation therapy) is shown at small-celled cancer of a lung, limfoproliferativny diseases. However simultaneous carrying out chemotherapy and radiation therapy is often connected with increase in number of complications (a dysphagy, a neutropenia) therefore the step-by-step combination therapy is more preferable (at first treatment by cytostatics, and then radiation or on the contrary).
Treatment by anticoagulants or fibrinolitic drugs is shown at a vein thrombosis. But these drugs should not be appointed standardly unless at a flebografiya thrombosis of an upper vena cava is diagnosed or there are no improvement signs at treatment by other methods.
