Superior Vena Cava Syndrome: A Challenge for an Internist in a Peripheral Hospital

Abstract

Superior vena cava syndrome results from decrease or obstruction in the venous flow of the head, neck and upper limbs due to thrombosis or extrinsic compression of the vena cava. It can have different etiologies, the neoplastic cause being one of the most frequent, constituting an oncological urgency. In an initial approach, the use of corticosteroid therapy and intravenous diuretics, combined with the elevation of the headboard are fundamental measures. In addition, treatment of the underlying disease, emergency radiotherapy and intervention radiology are the most relevant options. The authors propose to present a series of cases that emerged in the emergency department of a district hospital during the period of one year. Two cases appeared in patients with already known neoplasia (bronchial MALT lymphoma and papillary thyroid carcinoma with pulmonary and mediastinal metastasis) and under treatment. Another patient had a nodular formation at the level of the right upper lung lobe, without histological identification. In the other case, this syndrome was the initial presentation, with complementary exams showing the presence of a mediastinal mass, biopsied through mediastinoscopy, which revealed diffuse large B-cell lymphoma. The patients were aged between 61 and 81 years old. For all, support was requested from a central hospital for the lack of intervention radiology and radiotherapy in our hospital. Superior vena cava syndrome can have several etiologies, with the cases described occurring in the context of oncological disease. This series of cases alerts us to the clinical and, above all, therapeutic challenge in a district hospital, as well as reinforcing the importance of a multidisciplinary and inter-hospital team to better orient patients, seeking to offer the best therapeutic alternatives.