Superior Vena Cava Compression Syndrome in the Elderly
Introduction
Introduction to superior vena cava compression syndrome in the elderly The superior vena cava compression syndrome is a subacute syndrome, and it is rare in real acute cases. Before the blood flow from the superior vena cava system returns to the right atrium, the syndrome that occurs due to the stenosis or occlusion of part or all of the lumen of the vena cava, so that the blood flow is blocked, is called the superior vena cava compression syndrome. basic knowledge Sickness ratio: 0.5% Susceptible people: the elderly Mode of infection: non-infectious Complications: difficulty swallowing
Cause
The cause of superior vena cava compression syndrome in the elderly
(1) Causes of the disease
The causes of obstruction of the superior vena cava are as follows: thrombosis, fibrosis, external compression, tumor invasion, etc., benign diseases and malignant diseases, malignant tumors caused by superior vena cava compression syndrome often in tumor compression infiltration, etc. Based on the factors, it can be seen that the most common cause of superior vena cava compression syndrome is lung cancer, especially small cell lung cancer, followed by lymphoma, while other tumors are rare.
(two) pathogenesis
The superior vena cava is located in the upper mediastinum, and its wall is thin and soft. The compression of the vessel wall may cause the lumen of the blood vessel to narrow and the blood flow to be blocked. The surrounding superior vena cava is surrounded by hard organ tissue, with thymus, main trachea, right. The bronchus, aorta, brachiocephalic artery, hilar and paratracheal lymph nodes, any part of these structures can be inflated to compress the superior vena cava. The superior vena cava is the trunk of the head, neck, upper limbs, and upper thoracic blood flow. Compression can lead to increased venous pressure and congestion in these areas, followed by upper extremity edema, chest and pericardial oozing, and even tracheal edema, cerebral edema, and decreased cardiac output, accompanied by changes in consciousness, decreased vision, headache, etc. If the superior vena cava is pressed for too long, it may lead to local thrombosis and central nervous system damage. During the slow obstruction process, the medial, spinal, azygous, and thoracic collateral circulation may occur, showing characteristic characteristics. Shallow veins of the chest wall.
Prevention
Prevention of superior vena cava compression syndrome in the elderly
Early detection, early treatment, prevention of complications.
Complication
Complications of superior vena cava compression syndrome in the elderly Complications, difficulty swallowing
When the superior vena cava is severely compressed, it may be accompanied by an increase in intracranial pressure and difficulty in swallowing.
Symptom
Symptoms of superior vena cava compression syndrome in the elderly Common symptoms Multi-blood pleural effusion facial edema nausea chest pain chest wall vascular filling convulsion neck thick edema with dyspnea, purpura upper extremity edema
The symptoms and signs of the superior vena cava compression syndrome are related to the compression time, the degree of compression, the compression site, the time is short, the degree of obstruction is heavy, and the condition is often severe. Conversely, the condition is mild, and the clinical symptoms are cough and headache. Head swelling, nausea, visual acuity change, hoarseness, difficulty in swallowing, convulsions, etc., facial edema is found during physical examination, neck is thick, bloody, neck and chest vascular engorgement, when blocking azymatic vein, chest wall and upper abdominal wall Visible dilated veins, if blocked at the end of the superior vena cava and the junction of the azygous vein, the dilated venous branch can be seen in the upper chest. When the superior vena cava is severely obstructed, signs of obstruction of the airway may occur (for wheezing), or cranial The performance of elevated pressure, this situation should be quickly diagnosed and treated, malignant lymphoma, small cell lung cancer complicated by this serious situation, often get good results after chemotherapy, in a group of superior vena cava compression In the clinical manifestations of 371 cases, facial swelling accounted for 63%, head swelling accounted for 50%, cough accounted for 24%, upper limb swelling accounted for 18%, chest pain accounted for 15%, hypopharyngeal difficulty accounted for 9%, and jugular vein filling accounted for 60%. %, chest wall blood Filling 54%, 46% facial edema, sanguine 19%, 20% purple, 19% upper extremity edema.
Examine
Examination of superior vena cava compression syndrome in the elderly
When malignant tumors are infected, white blood cells are elevated.
X-ray examination is the most common: mediastinal widening, right hilar mass, and a small number of pneumonia infiltrates.
Diagnosis
Diagnosis and diagnosis of superior vena cava compression syndrome in the elderly
diagnosis
When typical signs and symptoms appear, the superior vena cava compression syndrome is very easy to diagnose. When the superior vena cava compression syndrome is not typical, the occlusion and the cause should be determined by angiography and radionuclide angiography. CT-enhanced scanning is a commonly used method. MRI can also be used to display tumors, thrombus and collateral circulation. X-ray examination is most commonly used. Parish et al reported 80 cases of superior vena cava syndrome: chest X-ray findings: upper mediastinum Broadening accounted for 64%, pleural effusion accounted for 26%, right hilar mass accounted for 12%, pneumonia infiltration accounted for 7%, paratracheal lymph node accounted for 5%, mediastinal mass accounted for 3%, chest X-ray showed normal 16% The superior vena cava compression syndrome often occurs during the progression of the tumor. In most cases, the etiological diagnosis is easier, but the diagnosis of a small number of patients is more difficult. In clinical work, the etiology should be diagnosed first. In the case of difficult diagnosis of the cause, there should be sufficient clinical evidence and then treatment, otherwise, anti-tumor treatment should not be carried out.
Differential diagnosis
Clinically, benign tumors and malignant tumors must be distinguished.
