Saturday, November 3, 2018

SVC syndrome - immediate relief

Q: The best initial corrective course of action for patients presenting with life-threatening superior vena caval (SVC) syndrome is (select one) 

 A) endovenous recanalization of SVC 
 B) Immediate Radiation therapy (RT)

 Answer: A

Symptomatic life-threatening SVC syndrome is a true medical emergency as the risk of sudden airway compromise or cerebral edema, resulting in death is very high.

In the past, after securing airway, conventional teaching was to perform immediate RT to provide rapid relief. Since endovenous recanalization stent placement is widely available, it should be considered a first line of treatment for the relief of immediate symptoms. RT if given prior to biopsy may obscure the histologic diagnosis, which should be a priority in these cases.



Loeffler JS, Leopold KA, Recht A, et al. Emergency prebiopsy radiation for mediastinal masses: impact on subsequent pathologic diagnosis and outcome. J Clin Oncol 1986; 4:716.

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