BACKGROUND Although superior vena cava(SVC)syndrome has also been reported as a late complication of pacemaker(PM)implantation,acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantatio...BACKGROUND Although superior vena cava(SVC)syndrome has also been reported as a late complication of pacemaker(PM)implantation,acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantation is very rare.There are no specific therapies or guidelines.CASE SUMMARY A 96-year-old woman receiving dialysis was implanted with a PM due to sick sinus syndrome.She was referred to our facility for chest discomfort experienced during dialysis.Upon examination,unilateral pleural effusion on the right side was cloudy with a foul odour.The patient was diagnosed with pyothorax and treated with antibiotics.After the effusion was reduced,it gradually reaggravated and remained cloudy.In this case,SVC syndrome,which is generally considered a late complication after PM implantation,rapidly developed following the bacteraemia,resulting in impaired venous return,chylothorax,and disdialysis syndrome.After catheter intervention for SVC stenosis,the patient’s symptoms promptly improved.The patient has been recurrence-free for a year.CONCLUSION Acute SVC syndrome can cause dysdialysis in PM-implanted patients.Catheter intervention alone has improved this condition for a traceable period.展开更多
Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth ...Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.展开更多
We here report a recent, rare case of Budd-Chiari syndrome, associated with a combination of hepatic vein and superior vena cava occlusion. A young female, who had been ingood health, was admitted to our hospital beca...We here report a recent, rare case of Budd-Chiari syndrome, associated with a combination of hepatic vein and superior vena cava occlusion. A young female, who had been ingood health, was admitted to our hospital because of massive ascites. The patient had used no oral contraceptives. Tests for coagulation disorders, hematological disorders, and antiphospholipid syndrome were all negative. BuddChiari syndrome was diagnosed by radiographic examination. The patient was suffering from a combination of hepatic vein and superior vena cava occlusion. In particular, the venous flow returned from the liver mainly through a right accessory hepatic vein, and stenosis was recognized at the orifice of this collateral vein into the vena cava.Subsequently, the patient underwent percutaneous balloon dilatation therapy for this stenosis. After this treatment, the massive ascites was gradually reduced, and she was discharged from our hospital. It has now been one year since discharge, and the patient has been doing well. If deteriorating liver function or intractable ascites occur again, a liver transplantation may be anticipated. This is the first case report of Budd-Chiari syndrome associated with a superior vena cava occlusion.展开更多
The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more com...The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more common groups [group 2(PH due to left heart disease) and group 3(PH due to lung diseases and/or hypoxia)], then group 4(chronic thromboembolic PH and other pulmonary artery obstructions) and finally group 1(pulmonary arterial hypertension) and group 5(PH with unclear and/or multifactorial mechanisms).[1] In this case, we demonstrate a rare scenario of obstruction-caused group 4 PH.展开更多
Objective To evaluate value of endovascular stent in treatment of superior vena cava syndrome(SVCS) caused by pulmonary carcinoma.Methods There were ten diagnosed SVCS male patients,aged from 63 to 81.With DSA scannin...Objective To evaluate value of endovascular stent in treatment of superior vena cava syndrome(SVCS) caused by pulmonary carcinoma.Methods There were ten diagnosed SVCS male patients,aged from 63 to 81.With DSA scanning,the lesion was confirmed and localized through angiography.Appropriate stent was advanced and inserted at a right place.Stents were observed for their positions by fluoroscopy or chest films and patency of blood stream by echo-Doppler during follow-up.Results Initial clinical success was achieved to 100%.Average venous pressure of distal end of SVC decreased from 31.5 cm H2O before and 14.7 cm H2O(P<0.05) after stent insertion,and related clinical symptoms and signs significantly alleviated or disappeared within 2～3 days.No symptoms or signs of stents displacement or pulmonary embolism could be detected during follow-up.Recurrent symptoms of SVCS were found in two cases,one was conduced by thrombosis at the stent three days after operation,and the others were caused by carcinoma progression 90 days after operation.Five cases survived for 11,11,12,14,20 months up to now.Conclusion Percutaneous endovascular stent insertion is a mini-invasive,effective,rapid technique and usually the first choice of treatment for palliation of SVCS.To prolong survival,appropriate treatment of pulmonary carcinoma is important.展开更多
Stent placement is the preferred means of managing malignant obstruction of the superior vena cava(SVC). Persistent left and absent right SVC is a very rare venous anomaly. We here report the case of a 58-year-old man...Stent placement is the preferred means of managing malignant obstruction of the superior vena cava(SVC). Persistent left and absent right SVC is a very rare venous anomaly. We here report the case of a 58-year-old man who underwent percutaneous stenting for malignant persistent left and absent right SVC obstruction caused by advancement of adenocarcinoma of the upper lobe of the left lung. The patient became symptom-free one day after endovascular stenting through the right femoral vein. However, he experienced repeated supraventricular tachycardia during the procedure. To our knowledge, this is the first report of stenting for malignant SVC obstruction with this congenital anomaly.展开更多
A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department.Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius...A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department.Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor.Chest contrast computed tomography revealed the tumor invaded right pulmonary artery,superior vena cava,and the persistant left superior vena cava flowed into the coronary sinus.The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava(SVC)utilizing ringed polytetrafluoroethylene graft.To the best of our knowledge,this was the first report of complete resection of locally advanced lung cancer involving superior vena cava,right pulmonary artery trunk and main bronchus with persistant left superior vena cava.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients...BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.展开更多
Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosi...Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA）.Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females （mean age of 59.1 years） with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was （3.32±1.79） cm （range,1.69 to 9.50 cm） and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of （2.14±0.49） cm （range,1.73 to 3.01 cm）.An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases （10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma）.In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin＇s lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.展开更多
Superior vena cava syndrome （SVCS） is a clinical syndrome caused by compression or invasion of the superior vena cava or thrombus formation within the superior vena cava.SVCS is typically the most common emergency a...Superior vena cava syndrome （SVCS） is a clinical syndrome caused by compression or invasion of the superior vena cava or thrombus formation within the superior vena cava.SVCS is typically the most common emergency associated with tumors.The rapid progression of the disease necessitates immediate treatment.展开更多
Unroofed coronary sinus syndrome (UCSS) is uncommon. In more than 3170 congenital heart defect patients undergoing open-heart surgery at Xinhua Hospital between 1973 and 1988 there were 6 cases with an incidence rate ...Unroofed coronary sinus syndrome (UCSS) is uncommon. In more than 3170 congenital heart defect patients undergoing open-heart surgery at Xinhua Hospital between 1973 and 1988 there were 6 cases with an incidence rate of approximately 0.18%. Two patients belonged to the complete type while 4 patients to the partial type. The pericardial patch treated by 0.5% glutaraldehyde was sewn into the right atrium so as to receive the left superior vena cava (LSVC) drainage. Neither residural shunt nor obstruction was detected by two-dimensional echocardiography in the follow-up.展开更多
文摘BACKGROUND Although superior vena cava(SVC)syndrome has also been reported as a late complication of pacemaker(PM)implantation,acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantation is very rare.There are no specific therapies or guidelines.CASE SUMMARY A 96-year-old woman receiving dialysis was implanted with a PM due to sick sinus syndrome.She was referred to our facility for chest discomfort experienced during dialysis.Upon examination,unilateral pleural effusion on the right side was cloudy with a foul odour.The patient was diagnosed with pyothorax and treated with antibiotics.After the effusion was reduced,it gradually reaggravated and remained cloudy.In this case,SVC syndrome,which is generally considered a late complication after PM implantation,rapidly developed following the bacteraemia,resulting in impaired venous return,chylothorax,and disdialysis syndrome.After catheter intervention for SVC stenosis,the patient’s symptoms promptly improved.The patient has been recurrence-free for a year.CONCLUSION Acute SVC syndrome can cause dysdialysis in PM-implanted patients.Catheter intervention alone has improved this condition for a traceable period.
文摘Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.
文摘We here report a recent, rare case of Budd-Chiari syndrome, associated with a combination of hepatic vein and superior vena cava occlusion. A young female, who had been ingood health, was admitted to our hospital because of massive ascites. The patient had used no oral contraceptives. Tests for coagulation disorders, hematological disorders, and antiphospholipid syndrome were all negative. BuddChiari syndrome was diagnosed by radiographic examination. The patient was suffering from a combination of hepatic vein and superior vena cava occlusion. In particular, the venous flow returned from the liver mainly through a right accessory hepatic vein, and stenosis was recognized at the orifice of this collateral vein into the vena cava.Subsequently, the patient underwent percutaneous balloon dilatation therapy for this stenosis. After this treatment, the massive ascites was gradually reduced, and she was discharged from our hospital. It has now been one year since discharge, and the patient has been doing well. If deteriorating liver function or intractable ascites occur again, a liver transplantation may be anticipated. This is the first case report of Budd-Chiari syndrome associated with a superior vena cava occlusion.
文摘The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more common groups [group 2(PH due to left heart disease) and group 3(PH due to lung diseases and/or hypoxia)], then group 4(chronic thromboembolic PH and other pulmonary artery obstructions) and finally group 1(pulmonary arterial hypertension) and group 5(PH with unclear and/or multifactorial mechanisms).[1] In this case, we demonstrate a rare scenario of obstruction-caused group 4 PH.
文摘Objective To evaluate value of endovascular stent in treatment of superior vena cava syndrome(SVCS) caused by pulmonary carcinoma.Methods There were ten diagnosed SVCS male patients,aged from 63 to 81.With DSA scanning,the lesion was confirmed and localized through angiography.Appropriate stent was advanced and inserted at a right place.Stents were observed for their positions by fluoroscopy or chest films and patency of blood stream by echo-Doppler during follow-up.Results Initial clinical success was achieved to 100%.Average venous pressure of distal end of SVC decreased from 31.5 cm H2O before and 14.7 cm H2O(P<0.05) after stent insertion,and related clinical symptoms and signs significantly alleviated or disappeared within 2～3 days.No symptoms or signs of stents displacement or pulmonary embolism could be detected during follow-up.Recurrent symptoms of SVCS were found in two cases,one was conduced by thrombosis at the stent three days after operation,and the others were caused by carcinoma progression 90 days after operation.Five cases survived for 11,11,12,14,20 months up to now.Conclusion Percutaneous endovascular stent insertion is a mini-invasive,effective,rapid technique and usually the first choice of treatment for palliation of SVCS.To prolong survival,appropriate treatment of pulmonary carcinoma is important.
文摘Stent placement is the preferred means of managing malignant obstruction of the superior vena cava(SVC). Persistent left and absent right SVC is a very rare venous anomaly. We here report the case of a 58-year-old man who underwent percutaneous stenting for malignant persistent left and absent right SVC obstruction caused by advancement of adenocarcinoma of the upper lobe of the left lung. The patient became symptom-free one day after endovascular stenting through the right femoral vein. However, he experienced repeated supraventricular tachycardia during the procedure. To our knowledge, this is the first report of stenting for malignant SVC obstruction with this congenital anomaly.
文摘A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department.Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor.Chest contrast computed tomography revealed the tumor invaded right pulmonary artery,superior vena cava,and the persistant left superior vena cava flowed into the coronary sinus.The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava(SVC)utilizing ringed polytetrafluoroethylene graft.To the best of our knowledge,this was the first report of complete resection of locally advanced lung cancer involving superior vena cava,right pulmonary artery trunk and main bronchus with persistant left superior vena cava.
基金the Chongqing Medical Scientific Research Project(a joint project of the Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX046。
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.
文摘Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA）.Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females （mean age of 59.1 years） with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was （3.32±1.79） cm （range,1.69 to 9.50 cm） and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of （2.14±0.49） cm （range,1.73 to 3.01 cm）.An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases （10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma）.In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin＇s lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.
文摘Superior vena cava syndrome （SVCS） is a clinical syndrome caused by compression or invasion of the superior vena cava or thrombus formation within the superior vena cava.SVCS is typically the most common emergency associated with tumors.The rapid progression of the disease necessitates immediate treatment.
文摘Unroofed coronary sinus syndrome (UCSS) is uncommon. In more than 3170 congenital heart defect patients undergoing open-heart surgery at Xinhua Hospital between 1973 and 1988 there were 6 cases with an incidence rate of approximately 0.18%. Two patients belonged to the complete type while 4 patients to the partial type. The pericardial patch treated by 0.5% glutaraldehyde was sewn into the right atrium so as to receive the left superior vena cava (LSVC) drainage. Neither residural shunt nor obstruction was detected by two-dimensional echocardiography in the follow-up.
