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Vincent Skovira, Maliha Ahmed, Thomas O. Genese
(Department of Internal Medicine, United Health Services Wilson Medical Center, Johnson City, NY, USA)
Am J Case Rep 2018; 19:1237-1240
Superior vena cava (SVC) syndrome can result from external compression or invasion of the vessel from structural pathology within the mediastinum. Here we present a case of a patient that had no airway compromise, but who had hemodynamic instability due to pulmonary vasculature compression requiring urgent intervention.
CASE REPORT: A 61-year-old male who presented with severe dyspnea was found to have newly diagnosed small cell carcinoma of the right lung. The carcinoma compressed the SVC as well as the right pulmonary artery (PA) as seen on computed tomography scanning. He became critically hypoxic and was emergently intubated. Due to the lack of airway compromise, this instance of SVC syndrome was not emergently treated with radiation or chemotherapy. However, he received appropriate treatment while on mechanical ventilatory support and eventually recovered.
CONCLUSIONS: SVC syndrome is considered an emergent condition in the setting of airway compromise. With the addition of PA compression, a case’s acuity should be reconsidered. Our case highlights the fact that SVC syndrome can be associated with compression of the right PA, due to its close proximity to the SVC. This can lead to rapid hemodynamic deterioration, thereby increasing the acuity when evaluating a patient with SVC syndrome. We recommend emergent intervention to be taken when a patient develops this combination of SVC syndrome and PA compromise.