Superior Vena Cava Syndrome
Superior Vena Cava Syndrome
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上腔静脉综合征
DOI：
10.1093/qjmed/hcz055
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Saito Fumitake
中科院分区：
文献类型：
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作者：
Horiuchi Kohei;Asakura Takanori;Saito Fumitake
一位先前健康的81岁男性来到我们的门诊，主诉有1个月的面部和躯干皮肤异常恶化史。他有30包年的吸烟史。体格检查显示胸部和腹部血管扩张（图1A），眶周水肿伴面部过多和嘴唇发绀（图1B），声音嘶哑。双侧肺音正常，上肢和下肢均无水肿。怀疑上腔静脉（SVC）综合征；胸片显示右上肺野肿块，计算机断层扫描显示纵隔浸润性肿块压迫SVC，提示SVC综合征。怀疑为肺癌，立即将患者转至大容量机构进行诊断和治疗，包括介入放射学和放射治疗。SVC综合征是SVC血流阻塞的临床表现，以面部、颈部和/或上肢肿胀为特征。其他特征包括面部过多，胸部和颈部静脉扩张以及发绀。尽管一些SVC综合征病例是由非恶性疾病引起的，如血栓形成和纤维化性纵隔炎，但60-85%的SVC综合征病例是由胸部恶性肿瘤引起的。值得注意的是，非小细胞肺癌是最常见的原因，占所有病例的50%，其次是小细胞肺癌（25%）和非霍奇金淋巴瘤（10%）。1喉水肿和脑水肿可导致猝死，因此及时发现并及时干预是非常重要的。2在本例中，我们可以根据SVC综合征的皮肤病学表现胸腔静脉扩张（53%的SVC综合征患者可见）和面部过多（20%的SVC综合征患者可见）来诊断SVC综合征。1医生应了解SVC综合征的皮肤病学表现，因为及时诊断和治疗可能会改善胸部恶性肿瘤（如肺癌）的预后。
A previously healthy 81-year-old man presented to our outpatient clinic was complaining of a 1-month history of a worsening skin abnormality of the face and trunk. He had a smoking history of 30 pack-years. Physical examination revealed distended vessels on the chest and abdomen (Figure 1A), periorbital edema with facial plethora and cyanosis of the lips (Figure 1B) and voice hoarseness. Lung sounds were normal bilaterally, and neither the upper nor lower extremities were edematous. Superior vena cava (SVC) syndrome was suspected; a chest radiograph showed a mass in the right upper lung field, and computed tomography revealed an invasive mass in the mediastinum compressing the SVC, suggestive of SVC syndrome. Lung cancer was suspected and the patient was immediately transferred to a high-volume institution for diagnosis and therapy, including interventional radiology and radiation therapy. SVC syndrome is the clinical manifestation of obstruction of blood flow in the SVC, characterized by facial, neck and/or upper extremity swelling. Other features include facial plethora, distended chest and neck veins and cyanosis. Although some cases of SVC syndrome are caused by non-malignant conditions, such as thrombosis and fibrosing mediastinitis, thoracic malignancies are responsible of 60–85% of SVC syndrome cases. Notably, non-small-cell lung cancer was the most common cause, accounting for 50% of all cases, followed by small-cell lung cancer (25%) and non-Hodgkin lymphoma (10%). 1 Detection of the syndrome and rapid intervention is highly important as laryngeal and cerebral edema may cause sudden death. 2 In this case, we could diagnose SVC syndrome based on its dermatological manifestation of distended chest veins (seen in 53% of patients with SVC syndrome) and facial plethora (seen in 20% of patients with SVC syndrome). 1 Physicians should be aware of the dermatological presentation of SVC syndrome because prompt diagnosis and treatment may result in the improvement of prognosis in cases with thoracic malignancies, such as lung cancer.