Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Rarely does superior vena cava syndrome constitute a medical emergency. The
ABCs of care are always a priority, insuring that the Airway is well maintained,
Breathing is adequate and the Circulation (blood pressure and heart rate) is
stable. The patient may feel more comfortable in an upright position. Furosemide
(Lasix) is a diuretic that will decrease the volume of fluid
within the bloodstream. With less pressure pushing against the obstructed
superior vena cava, symptoms may be temporarily relieved.
Treatment needs to be directed to the underlying cause.
If the cause is a tumor or cancer, the treatment plan will need to be
customized to the patient's condition and desires. Options include radiation
with or without chemotherapy.
Even with aggressive treatment with radiation,
only 10 % of lung cancer patients with this syndrome survived to 30 months.
Without any treatment, survival may be less than a month.
Steroids [for example,
methylprednisolone (Medrol, Depo-Medrol) or prednisone
(Deltasone, Liquid Pred)], may be considered to decrease
the swelling of a tumor pressing on the superior vena cava and help relieve
symptoms.
If the cause of superior vena cava syndrome is a blood clot, anticoagulation
with (warfarin) Coumadin may be indicated.
The use of thrombolytic
drugs [for example, alteplase
(Activase, TPA) or TNK] to break up the clot, or placement of a stent to keep
the vein open may also be considered.
Special consideration
In children, superior vena cava syndrome is most often caused by
non-Hodgkin's lymphoma. The compression of the superior vena cava may be
associated with compression of the trachea as well. The trachea (windpipe) in
children is relatively narrow, flexible, and soft as compared with an adult.
Airway obstruction may occur and manifest as:
difficulty breathing,
stridor
(high-pitched, abnormal breathing sounds heard when breathing in), and
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Hoarseness (abnormal deep, harsh, raspy voice) is caused by a variety of conditions in which the larynx (voice box and vocal chords) are irritated or injured. Examples of causes of hoarseness include: laryngitis, straining the vocal cords by yelling or screaming, infections, GERD, allergies, and more. Treatment of hoarseness depends on the cause.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
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