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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Hematology & Oncology : Superior Mediastinal/Vena Cava Syndrome

Usually seen in Hodgkin's and Non-Hodgkin's lymphoma, T cell ALL

Clinical features

  • Plethora, facial swelling
  • Engorged neck and facial veins
  • Orthopnea, hypoxia, dizziness
  • Dysphagia and drooling are late ominous signs (as espophagus is posterior)

Management

  • Airway control is very important
  • Supplemental Oxygen
  • CXR, CT or MRI to access the airway; avoid sedation
  • Place IV in legs. DO NOT PLACE IV IN UPPER EXTREMITIES (as it drains to SVC which is already obstructed)
  • Emergency treatment includes Steroids, radiation which often precedes any diagnostic study
  • Attempt to diagnose underlying malignancy if possible (eg. BMA and Bx under local anesthesia, pleural or pericardiocentesis)


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