CXR: Superior vena caval syndrome

By:

Dr Jami Swathi

Prof Dr.A.Gowrishankar’s unit

A 45 yr old male presented with chief complaints of

puffiness of the face , headache and redness of eyes for

3 days

Chest X ray PA viewTrachea appears centralB/L lung fields appear normalHeart shadow appears normalSkeletal framework & soft tissues appear normalSuperior mediastinum appears widened on the rt side

irregular lateral border merging with the mediastinal shadow

Rt hilum not visualised. Lt hilum appears normalCostophrenic & cardiophrenic angles appear normal

Chest x ray lateral view – underpenetrated

Confirms superior mediastinal widening

SUPERIOR VENA CAVAL SYNDROME

Bronchogenic carcinoma- most commonLymphomasGerm cell tumorAortic aneurysm/ dissection Mediastinal abscessRetrosternal goitreLeft brachiocephalic vein aneurysmCong heart disease –TAPVC-rareMediastinal lipomatosis(rare)

Occurs due to SVC obstruction, with severe reduction in venous return from the head, neck and upper extremities.

NEOPLASTIC: Bronchogenic ca lymphomas thymomas germ cell tumors metastatic breast caNON NEOPLASTIC: aortic aneursym/ dissection svc thrombosis mediastinal fibrosis histoplasmosis retrosternal goitre

Patients usually present with neck and facial swelling, dyspnoea and cough.

Other symptoms Include

Hoarseness, tongue swelling ,headache, nasal congestion, epistaxis

Hemoptysis, dysphagia, chest pain, dizziness, syncope, lethargy

Dilated neck veinsCyanosisEdema of face, arms, chestIn severe cases

ProptosisGlossal and laryngeal edemaObtundationSigns and symptoms of cerebral/laryngeal edema

The clinical picture is milder if the obstruction is above the azygos vein.

Is usually clinicalChest X ray findings: superior mediastinal widening -64% pleural effusion -25% rt hilar mass -10% b/l diffuse infiltrates -7% cardiomegaly -6% calcified para tracheal nodes -5% mediastinal mass -3% NORMAL -16%

GENERAL MEASURES: Bed rest head end elevation oxygen diuretics steroids• Tracheal obstruction is a life threatening complication

needing emergent therapy• TREATMENT OF THE CAUSE

Superior mediastinal widening on the rt side.

Irregular lateral border, medially merging with mediastinal shadow. Superior Rt cardiac border (formed by SVC) not seen separately. Hilum is not seen through it. Hence anteriorly located in the mediastinum. Lat x-ray not much contributory (underpenetrated), if at all, u can say it confirms the location, overlying superior mediastinum, and not posterior (overlying spine). D/D and discussion are ok in the presentation. U can add thymic mass (thymoma / thymic ca) in differentials.