Patient presents with elevated JVP on right side with positive Kussmaul sign. SVC obstruction is being suspected. SVC obstruction is commonly seen in:
Ans: C (Small cell lung cancer) Ref: Schwartz Textbook of Surgery. 10th edition, pg: 623Explanation:Superior Vena Cava Syndrome (SVCS)Characteristic Featureso Edema of upper trunk,o Distension of neck veins,o Conjunctival edema,o Chylothorax.o Collateral veins in anterior chest wall,o Cyanosis.o Edema of forearm and chest.Causes of SVCSo Squamous cell and Small cell Lung Ca - Most Common cause.o Lymphoma.o Thrombosis following Intra Venous catheter use. o Metastasis from Testicular and Breast Ca.Small Cell Lung Cancer occurs in Submucosa of airways and produces perihilar mass which can cause SVC obstruction.Most significant Chest Radiographic finding: Widening of superior mediastinum (Most Common on right side).Most reliable diagnostic test is CT Scan.Life threatening complication of Superior mediastinal mass is Tracheal obstruction.Treatmento Non small cell lung cancer: Radiation therapy,o Metastatic tumors: Radiation therapy,o Small cell carcinoma of lung: Chemotherapy.o Lymphoma: Chemotherapy.o Other causes: Surgery'.Other OptionsAdenocarcinoma and Pancoasts tumor are peripherally located and usually does NOT involve SVC.Pancoast's tumor is:o Carcinoma arising from apex of the upper lobe of lung,o Upper limb pain.o Atrophy of the muscles of the hand,o Horner's syndrome.Recurrent laryngeal nerve involvement occurs most commonly on the left side due to hilar location of RLN as it passes under aortic arch.
Pancoast tumour
Adenocarcinoma
Smalt cell lung cancer
Patient can present with hoarseness of voice
Lung Cancer