Document Type : Case Report(s)
Authors
Department of Pulmonary Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, India
Abstract
Superior vena cava (SVC) syndrome is not an uncommon occurrence in patients with malignancy and it is often described as a medical emergency. In majority of the cases, SVC syndrome occurs due to mechanical obstruction of the SVC by extraluminal compression with primary intrathoracic malignancies. However, intraluminal obstruction due to thrombosis can also produce symptoms and signs of SVC syndrome. Clot-related SVC obstruction is mostly associated with indwelling central venous catheter and pacemaker leads, although such thrombosis can occur spontaneously in a background of a hypercoagulable state, e.g., malignancy. Here, an unusual case of sudden onset SVC syndrome has been reported, which on initial radiologic evaluation was found to have a lung nodule without any significant mediastinal mass or adenopathy compressing SVC. Subsequent investigation with Doppler ultrasonography of the neck showed thrombosis in the right internal jugular, right subclavian and right brachiocephalic vein, which was responsible for SVC syndrome. Histopathological evaluation of lung nodule confirmed presence of an adenocarcinoma. Therefore, venous thromboembolism as a paraneoplastic syndrome should be kept in mind while evaluating a case of SVC obstruction in a cancer patient. Management of the underlying disease is of prime importance in such cases and anticoagulation is the mainstay of therapy. Ability to identify paraneoplastic syndrome may have a significant effect on clinical outcome, ranging from early diagnosis to improved quality of life of the patient.
Keywords
- May M, Seehafer M, Helke C, Uberruck T, Gunia S, Hoschke B. [Superior vena cava syndrome with bilateral jugular and subclavian vein thrombosis. Paraneoplastic manifestion of renal cell carcinoma]. Urologe A. 2003;42:1374-7. doi: 10.1007/s00120-003-0401-9. PubMed PMID: 14569387.
- Kimura T, Chino M, Ogasawara N, Nakano T, Izumi S, Takeuchi H. Trousseau's syndrome with brachiocephalic vein thrombosis in a patient with uterine carcinosarcoma. A case report. Angiology. 1999;50:515-8. doi: 10.1177/000331979905000611. PubMed PMID: 10378829.
- Silvestri GA, Jett JR. Clinical aspects of lung cancer. In: Mason RJ, Broaddus VC, Martin TR, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA, editors. Murray and Nadelâs Textbook of Respiratory Medicine. 5th ed. Vol. 2. Philadelphia: Elsevier Saunders; 2010. p. 1116-44.
- Heinemann S, Zabel P, Hauber H-P. Paraneoplastic syndromes in lung cancer. Cancer Therapy. 2008;6:687-98.
- Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010;85:838-54. doi: 10.4065/mcp.2010.0099. PubMed PMID: 20810794; PubMed Central PMCID: PMC2931619.
- Tesselaar ME, Osanto S. Risk of venous thromboembolism in lung cancer. Curr Opin Pulm Med. 2007;13:362-7. doi: 10.1097/MCP.0b013e328209413c. PubMed PMID: 17940477.
- Shaikh I, Berg K, Kman N. Thrombogenic catheter-associated superior vena cava syndrome. Case Rep Emerg Med. 2013;2013:793054. doi: 10.1155/2013/793054. PubMed PMID: 24194987; PubMed Central PMCID: PMC3806322.
- Khorana AA. Cancer-associated thrombosis: updates and controversies. Hematology Am Soc Hematol Educ Program. 2012;2012:626-30. doi: 10.1182/asheducation-2012.1.626. PubMed PMID: 23233644.
- Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146-53. doi: 10.1056/NEJMoa025313. PubMed PMID: 12853587.
- Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F, et al. Aspirin, warfarin, or enoxaparin thromboprophylaxis in patients with multiple myeloma treated with thalidomide: a phase III, open-label, randomized trial. J Clin Oncol. 2011;29:986-93. doi: 10.1200/JCO.2010.31.6844. PubMed PMID: 21282540.
)