WordNet

of or characteristic of high rank or importance; "a superior ruler"
one of greater rank or station or quality (同)higher-up, superordinate
the head of a religious community
(often followed by `to'
(sometimes followed by `to'
having an orbit farther from the sun than the Earths orbit; "Mars and Jupiter are the closest in of the superior planets"
of high or superior quality or performance; "superior wisdom derived from experience"; "superior math students"
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
a town in northwest Wisconsin on Lake Superior across from Duluth

PrepTutorEJDIC

(程度・質が)『普通(平均)以上に優れた』,優秀な / (地位・階級などが)『上位の』,上級の,目上の / (数量的に)勝る,優勢な / (用動が)偉ぶった,高慢な / 《補語にのみ用いて》(…に)屈しない,動じない《+to+名》 / 《名詞の前にのみ用いて》(動・植物の器官や部分が)上位の,上についている / (地位・階級などが)『上位の人』,上役,上司,先輩 / 『いっそう優れた人』 / 《しばしば S-》修道院長
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
スペリオル湖(lake~;北米五大湖中で最北最大のもの)
circa

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/30 22:51:21」(JST)

wiki en

Superior vena cava syndrome (SVCS), is a group of symptoms caused by obstruction of the superior vena cava (a short, wide vessel carrying circulating blood into the heart). More than 90% of cases of superior vena cava obstruction (SVCO) are caused by cancer - most commonly bronchogenic carcinoma, typically a tumor outside the vessel compressing the vessel wall - but it can, sometimes, have a benign cause. Characteristic features are edema (swelling due to excess fluid) of the face and arms and development of swollen collateral veins on the front of the chest wall. Shortness of breath and coughing are quite common symptoms; difficulty swallowing is reported in 11% of cases, headache in 6% and stridor (a high-pitched wheeze) in 4%. The condition is rarely life-threatening, though edema of the epiglottis can make breathing difficult, and edema of the brain can cause reduced alertness, and in less than 5% of cases of SVCO, severe neurological symptoms or airway compromise are reported.^[1]

Signs and symptoms

Shortness of breath is the most common symptom, followed by face or arm swelling.^[2]

Following are frequent symptoms:

Dyspnea^[3]
Headache^[3]
Facial edema^[3]
Venous distention in the neck and distended veins in the upper chest and arms^[3]
Upper limb edema^[3]
Lightheadedness^[2]
Cough^[2]
Edema of the neck, called the collar of Stokes^[4]
Pemberton's sign^[3]

Superior vena cava syndrome usually presents more gradually with an increase in symptoms over time as malignancies increase in size or invasiveness.^[2]

Cause

Thrombosis of the superior vena cava caused by an indwelling central venous catheter which caused superior vena cava syndrome

Approximately 90% of cases are associated with a cancerous tumor that is compressing the superior vena cava,^[2] such as bronchogenic carcinoma including small cell and non-small cell lung carcinoma, Burkitt's lymphoma, lymphoblastic lymphomas, pre-T-cell lineage acute lymphoblastic leukemia (rare), and other acute leukemias.^[2] Syphilis and tuberculosis have also been known to cause superior vena cava syndrome.^[2] SVCS can be caused by invasion or compression by a pathological process or by thrombosis in the vein itself, although this latter is less common (approximately 35% due to the use of intravascular devices).^[2]

Diagnosis

A CXR of a person with lung cancer which was causing superior vena cava syndrome.

A CT image showing compression of the right hilar structures by cancer.

The main techniques of diagnosing SVCS are with chest X-rays (CXR), CT scans, transbronchial needle aspiration at bronchoscopy and mediastinoscopy.^[3] CXRs provide the ability to show mediastinal widening and may show the presenting primary cause of SVCS.^[3] CT scans should be contrast enhanced and be taken on the neck, chest, lower abdomen and pelvis.^[3] They may also show the underlying cause and the extent to which the disease has progressed.^[3]

Treatment

Several methods of treatment are available, mainly consisting of careful drug therapy and surgery.^[2] Glucocorticoids (such as prednisone or methylprednisolone) decrease the inflammatory response to tumor invasion and edema surrounding the tumor.^[2] Glucocorticoids are most helpful if the tumor is steroid-responsive, such as lymphomas. In addition, diuretics (such as furosemide) are used to reduce venous return to the heart which relieves the increased pressure.^[2]

In an acute setting, endovascular stenting by an interventional radiologist may provide relief of symptoms in as little as 12-24 hours with minimal risks.

Should a patient require assistance with respiration whether it be by bag/valve/mask, BiPAP, CPAP or mechanical ventilation, extreme care should be taken. Increased airway pressure will tend to further compress an already compromised SVC and reduce venous return and in turn cardiac output and cerebral and coronary blood flow. Spontaneous respiration should be allowed during endotracheal intubation until sedation allows placement of an ET tube and reduced airway pressures should be employed when possible.

Prognosis

Symptoms are usually relieved with radiation therapy within one month of treatment.^[2] However, even with treatment, 90% of patients die within two and a half years.^[2] This relates to the cancerous causes of SVC that are 90% of the cases. The average age of onset of disease is 54 years of age.^[2]

References

^ Kent, MS; Port, JL (2007). "Superior Vena Cava Syndrome". In Chang, AE; Ganz, PA; Hayes, DF et al. Oncology – An Evidence-based Approach. Springer Science & Business Media. pp. 1291–9. ISBN 0387310568. |displayeditors= suggested (help)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ emedicine > Superior Vena Cava Syndrome. Author: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Summa Health System. Updated: Dec 3, 2009
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Parker, Robert; Catherine Thomas; Lesley Bennett (2007). Emergencies in Respiratory Medicine. Oxford. pp. 96–7. ISBN 978-0-19-920244-7.
^ define:collar of Stokes at open-resource-project.org. Retrieved Mars 2011

External links

Superior vena cava syndrome at eMedicine
Wilson LD, Detterbeck FC, Yahalom J (May 2007). "Clinical practice. Superior vena cava syndrome with malignant causes". N Engl J Med. 356 (18): 1862–9. doi:10.1056/NEJMcp067190. PMID 17476012.
Randolph HL Wong, Joshua Chai, Calvin SH Ng, et al. Transvenous pacing lead-induced Superior Vena Cava Syndrome: What do we know? (2009). Surgical Practice 13 (4): 125–126. doi:10.1111/j.1744-1633.2009.00462.x. Missing or empty |title= (help)

UpToDate Contents

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1. 悪性腫瘍関連上大静脈症候群 malignancy related superior vena cava syndrome
2. Management of patients post-Fontan procedure
3. 肺癌の危険因子、病理、および臨床症状の概要 overview of the risk factors pathology and clinical manifestations of lung cancer
4. 小児癌患者の救急治療 emergencies in pediatric cancer patients
5. 透析でのアクセスに関連した中心静脈狭窄 central vein stenosis associated with dialysis access

English Journal

Acute Superior Vena Cava Syndrome After Rupture of Kommerell's Diverticulum: A Case Report.

Suarez AE, Slivka R.SourceDepartment of Emergency Medicine, New York Hospital Queens, Flushing, NY; and Weill Cornell Medical College, New York, NY. Electronic address: suarez.alison@gmail.com.
Annals of emergency medicine.Ann Emerg Med.2012 Sep 13. pii: S0196-0644(12)01416-3. doi: 10.1016/j.annemergmed.2012.08.018. [Epub ahead of print]
Kommerell's diverticulum, a rare congenital aortic anomaly, is dilatation at the region in which an aberrant subclavian artery branches from either a left-sided or right-sided thoracic aorta. We report a rare case of acute superior vena cava syndrome that developed in a young healthy male patient wh
PMID 22981139

Superior vena cava syndrome as a presentation of metastatic prostate cancer.

Yun HD, Ershler WB.SourceDepartment of Medicine, Harbor Hospital Center, Baltimore, Maryland, USA.
BMJ case reports.BMJ Case Rep.2012 Sep 3;2012. pii: bcr2012006480. doi: 10.1136/bcr-2012-006480.
Superior vena cava (SVC) syndrome is an uncommon complication of malignant disease caused by the obstruction of venous blood flow in the SVC. When present, a diagnosis of lung cancer or lymphoma will be made in approximately 95% of cases. Although other malignant diseases are occasionally associated
PMID 22948992

Japanese Journal

Superior vena cava syndrome causedby adult T-cell leukemia/lymphoma: a case report

Ikeda Takaya; Fukuda Minoru; Nakamura.et.al
Acta Medica Nagasakiensia 56(2), 59-61, 2011-08
… The lesion compressed the superior vena cava (SVC). … On autopsy, he was diagnosed that SVC syndrome caused by adult T-cell leukemia/lymphoma (ATL). … Although it is extremely rare, SVC syndrome can appear as the earliest symptom of ATL. …
NAID 110008767595

Rigid Bronchoscopy for Malignant Central Airway Obstruction from Small Cell Lung Cancer Complicated by SVC Syndrome

JUNG Bockhyun,MURGU Septimiu,COLT Henri
Annals of thoracic and cardiovascular surgery 17(1), 53-57, 2011-02-01
… Central airway obstruction (CAO) and superior vena cava (SVC) syndrome are potentially life-threatening complications in locally advanced lung cancer. … However, the technique may pose significant risks in patients with coexisting SVC syndrome, especially, and even more so perhaps in patients over the age of eighty. …
NAID 10029686360

Related Pictures

★リンクテーブル★

リンク元	「上大静脈症候群」
関連記事	「superior」「superio」「cava」「vena cava」「vena」

「上大静脈症候群」

Superior vena cava syndrome (Mediastinal syndrome)
	Superior vena cava syndrome in a person with bronchogenic carcinoma. Note the swelling of his face first thing in the morning (left) and its resolution after being upright all day (right).
Classification and external resources
ICD-10	I87.1
ICD-9	459.2
DiseasesDB	12711
MedlinePlus	001097
eMedicine	emerg/561
MeSH	D013479