A 53 years old patient was admitted complains of dyspnea. On examination he has face with engorged veins over the chest. SVC obstruction is suspected. Chest x-ray shows mediastinal enlargement. What is the next step?
SUPERIOR VENA CAVA (SVC) SYNDROME Clinical manifestation of SVC obstruction, with severe reduction in venous return from head, neck and upper extremities. MC cause is Lung cancer (small cell & squamous cell carcinoma)Q, along with lymphoma and metastatic tumors responsible for more than 90% of all SVC syndrome. In young adults, malignant lymphoma is the leading cause of SVC syndromeQ. CLINICAL FEATURES Patients present with neck & facial swelling (especially around the eyes), dyspnoea & coughQ. DIAGNOSIS Most significant chest radiographic finding is widening of the superior mediastinum (MC right side)Q CT scan: Investigation of choiceQ. TREATMENT Potentially life threatening complication of superior mediastinal mass is tracheal obstructionQ. Diuretics with low salt diet, head elevation and oxygen may produce temporary symptomatic relief. Treatment Underlying cause Radiation TherapyQ Non-small cell lung cancer, Metastatic solid tumors ChemotherapyQ Small cell carcinoma or lymphoma SurgeryQ All other cases
Total blood count with peripheral smear
CT thorax
Sta cyclophosphamide
Urgent referral to
Neck