Superior vena cava return obstruction

Introduction Superior vena cava obstruction syndrome is a syndrome in which complete or incomplete upper vena cava obstruction is caused by various causes, which hinders blood flow. The clinical manifestations were mainly upper limb and facial edema and cyanosis, and varicose veins of the chest wall. Most of the causes of obstruction of the superior vena cava are mediastinal or hilar tumors and mediastinal inflammation. A small number is due to superior vena cava thrombophlebitis. Most are caused by malignant tumors, such as lung cancer, primary mediastinal tumors, lymphomas and metastatic tumors.

Cause

(1) Causes of the disease

Most are caused by malignant tumors, such as lung cancer, primary mediastinal tumor, lymphoma and metastatic tumor, chronic mediastinal inflammation, primary superior vena cava thrombosis, etc. can also cause SVCS.

(two) pathogenesis

The superior vena cava is located in the stenotic right anterior superior mediastinum, posterior to the sternum, adjacent to the right main bronchus and ascending aorta. In the anastomosis with the azygous vein, the surrounding area is surrounded by lymph nodes; the lymph fluid of the entire right thoracic cavity and the lower left thoracic cavity flows through the above lymph nodes. A variety of factors are associated with superior vena cava obstruction. SVCS can be produced by a single or a combination of malignant tumors or metastatic lesions of the mediastinum and paratracheal lymph nodes, direct infiltration of the vessel wall and/or intravascular thrombosis, secondary inflammation, blood stasis, and platelet aggregation. Due to increased venous pressure and blocked lymphatic drainage, some patients may be accompanied by pleural effusion.

an examination

Related inspection

X-ray lipiodol angiography blood CT examination

Secondary inflammation can increase white blood cells.

X-ray chest radiograph can show upper mediastinal mass, mediastinal and paratracheal lymphadenopathy, pleural effusion, CT examination is more suitable for chest X-ray without typical findings. Endoscopic or thoracoscopic lung biopsy or lymph node biopsy, or cytology to determine the cause.

Clinical manifestations depend on the onset of illness, the location of obstruction, the degree of obstruction, and the formation of collateral circulation. Usually it is a recessive onset, more than half of which has a history of 2 to 4 weeks, and then there are special symptoms and signs. The most common symptoms are dyspnea, facial and neck edema, followed by trunk and upper extremity edema, chest pain, cough, and difficulty in swallowing. Central nervous system symptoms can occur if secondary intracranial pressure is elevated. Physical examination has chest, jugular vein dilatation, facial edema, shortness of breath, but also facial redness, upper limb cyanosis and edema, hoarseness and/or Horner syndrome.

Diagnosis can be made based on medical history, clinical manifestations, and auxiliary examinations.

Differential diagnosis

The subcutaneous vein is reticular: it is one of the clinical symptoms of thrombophlebitis. The disease is a venous disease characterized by acute non-suppurative inflammation of the vein wall and intraluminal thrombosis. Slow blood flow and eddy current formation, increased blood coagulation and endometrial damage are the main causes. Clinically, it is divided into superficial thrombophlebitis and deep vein thrombosis.

Inferior vena cava thrombosis: deep vein thrombosis is a common clinical disease, and inferior vena cava thrombosis is a serious type, with many complications and poor prognosis. In recent years, the incidence rate is on the rise, especially in the advanced stage of the tumor. Increased inferior vena cava thrombosis during tumor radiotherapy and chemotherapy and inferior vena cava thrombosis implantation has attracted the attention of doctors.

Venous reflux disorder: The process of circulating blood to the right atrium by the systemic venous canal. The systemic venous system has a large blood volume, accounting for more than half of the total blood. The vein is easily dilated and can contract, thus acting as a blood storage stock. The contraction and relaxation of the vein can effectively regulate the amount of blood return and cardiac output, so that the circulation function can adapt to the needs of the body in various physiological states. The basic force of venous return is the pressure difference between the venule (also known as the peripheral vein) and the vena cava or right atrium (also known as the central vein). An increase in venule pressure or a decrease in vena cava pressure is beneficial for venous return. Since the venous wall is thin and the venous pressure is low, the venous return is also affected by external force such as muscle contraction, respiratory motion, gravity, and the like. When the above factors hinder venous return, the body will exhibit various manifestations. Secondary inflammation can increase white blood cells.

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