Síndrome de vena cava superior como complicación del tratamiento con inmunoglobulinas intravenosas / Superior vena cava syndrome as a complication of intravenous immunoglobulin treatment

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Mesothelioma with superior vena cava obstruction in young female following short latency of asbestos exposure.

An 18 years female was admitted with right-sided chest pain, dry cough, and low-grade fever and weight loss for last 1 month. On examination, patient had features of superior vena cava (SVC) syndrome with right-sided pleural effusion. Chest X-ray showed mediastinal widening with nonhomogenous opacity mainly in the periphery of right upper and mid zone with right-sided pleural effusion. Ultrasonography thorax confirmed mild pleural effusion. Pleural fluid analysis showed lymphocytic, exudative, low adenosine deaminase with negative for Pap smear. Contrast-enhanced computed tomography (CT) thorax revealed large extensive nodular soft tissue lesion along right mediastinum as well as costal pleura, with enlarged pretracheal lymphadenopathy and SVC obstruction. CT guided Tru-cut biopsy report came as malignant epithelial tumor with polygonal shape, abundant eosinophilic cytoplasm and nuclei with prominent nucleoli suggestive of mesothelioma of epithelioid type. The tumor cell expressed calretinin, WT-1, and immunonegative for thyroid transcription factor-1.

Brain swelling in acute superior vena cava syndrome due to aortic dissection: unusual and lethal manifestation aggravated by induction of general anesthesia.

A 32-year-old woman with Marfan syndrome experienced acute superior vena cava syndrome due to aortic dissection. The patient had previously undergone a Bentall operation. The aneurysm from the ascending to the transverse aorta compressed the superior vena cava, the right pulmonary artery, and the trachea. The rare and life-threatening neurological complication in this patient may have been related to brain edema, which was revealed by preoperative computed tomography. The induction of general anesthesia aggravated the symptoms of the superior vena cava syndrome and led to a fatal condition. Additional cannulation in the right subclavian vein was mandatory to alleviate the symptoms because the venous drainage from the upper half of the body created only by the femorofemoral bypass was not adequate. Total arch replacement was performed. The postoperative course was uneventful.

Superior vena cava syndrome caused by chemotherapy-induced fibrosis.

We report a case of a 51-year old man with small cell lung cancer who developed superior vena cava syndrome due to obstruction of the superior vena cava at the junction of the brachiocephalic vein by a fibrotic band, 2 months after completing six cycles of chemotherapy with cisplatin and etoposid. Superior vena cava syndrome caused by chemotherapy-induced pulmonary fibrosis should be kept in mind during follow-up.

Efectos tóxicos de la infusión de morfina subcutánea en paciente con síndrome de vena cava superior / Toxic effects of the infusion of subcutaneos morphine in a patient with upper cava vein syndrome

Introducción: El objetivo del presente caso es describir un cuadro de toxicidad por opiáceos en un paciente con cáncer de pulmón y Síndrome de Vena Cava Superior (SVCS). Los efectos secundarios de la morfina fueron más acentuados en el territorio de drenaje de la vena. Caso clínico: Se presenta el caso clínico de un paciente de 65 años diagnosticado de cáncer de pulmón que desarrolla un SVCS. El enfermo refería dolor severo en región torácica y miembro superior derecho que requirió tratamiento con coadyuvantes, corticoides y opiáceos vía oral. En su evolución precisó la utilización de la vía parenteral, por lo que se le administró una perfusión subcutánea de morfina. A las 12 horas desarrolló un cuadro de enrojecimiento y prurito en hemitórax superior, cuello y cabeza con somnolencia y desorientación. Ante la sospecha de un cuadro de toxicidad local de la morfina, dado que la clínica era localizada, y al comprobar que el lugar de punción fue en el brazo derecho, se retiró la perfusión cediendo la sintomatología. Al reiniciarse la perfusión en el abdomen no volvieron a aparecer los efectos secundarios Conclusiones: En pacientes con Síndrome de Vena Cava Superior que precisen tratamiento con morfina por vía parenteral, debe evitarse el acceso en miembros superiores y tórax, ya que puede aparecer un cuadro de toxicidad local del opiáceo (AU)

Recurrent transient superior vena cava-like syndrome possibly associated with megestrol acetate.

BACKGROUND: Superior vena cava syndrome is a rare, life-threatening clinical entity associated with occlusion of venous outflow from the head, neck, and upper extremities; this syndrome produces facial edema, cyanosis, dyspnea, and prominent neck veins, and is usually caused by intrathoracic neoplasms. CASE: In this unusual case, a patient receiving megestrol acetate for stage IV endometrial carcinoma developed recurrent transient superior vena cava-like syndrome in the absence of venous obstruction. CONCLUSION: Superior vena cava-like syndrome may occur with megestrol acetate. This unusual complication should be considered in patients receiving this medication who present with symptomatology similar to that of superior vena cava syndrome.