Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
A 67-year-old African-American woman presented to the hospital with a several months' history of bilateral breast swelling, shortness of breath, voice hoarseness, head fullness and facial swelling. On physical examination, the patient was found to have engorged chest wall veins, bilateral arm and breast oedema and fullness of supraclavicular areas. Vital signs were normal and initial blood tests including complete blood account, complete metabolic profile did not reveal any abnormality. Her medical history was significant for hepatitis C virus infection, stroke and hypertension.
Chest x-ray was normal and CT of the chest with contrast showed chronic superior vena cava (SVC) obstruction with multiple chest wall lateral vessels consistent with chronic thrombus/fibrosis (figures 1 and 2, respectively). There were no lymphadenopathy and lung was free of infiltrate and consolidation.
Upon further questioning, it was found that 15 years ago the patient had an acute pancreatitis for which she had a right subclavian-implanted port placed for almost 5 years. Subsequent hypercoagulable work up was negative and CT of the abdomen and pelvis was unrevealing. Patient was taken for venography with potential percutaneous intervention. Venography confirmed chest CT findings showing complete occlusion of the SVC with extensive collateralisation (figure 3). Unfortunately, we could not cross occlusion with multiple guidewire and catheter combinations. Given fairly well-developed collateral vessels and non-debilitating nature of her symptoms, the decision was made to manage her conservatively with diuretics and compression garment to upper extremities.
Malignancy is considered the most common cause of SVC syndrome accounting for 60–90% of the cases. Increasing use of intravascular access devices like pacemakers, indwelling venous catheters made the benign aetiology as an emerging cause of SVC syndrome. Symptoms typically develop over a few weeks and then improve due to development of collateral vessels. Percutaneous stenting is the mainstay of treatment of non-malignant SVC syndrome.1–3
Widespread use of indwelling vascular devices has led to increasing incidence of superior vena cava (SVC) syndrome not caused by malignancy.
Patient might develop symptoms of SVC syndrome several years after removal of intravascular access device.
Contributors All authors contributed equally to the composition of this manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.