1/5. Superior vena cava thrombosis causing respiratory obstruction successfully resolved by stenting in a small bowel transplant candidate.A 4 year old child was referred for small bowel transplantation. He had superior vena cava obstruction secondary to numerous central venous line placements; alternative routes for long term central venous access were compromised by extensive venous occlusive disease. Patency for the superior vena cava was re-established with stenting, which allowed for radiological placement of another central venous line. Long term survival in infants and young children with intestinal failure is dependent on adequate central venous access for the administration of parenteral nutrition. Line sepsis and physical damage to the catheter often necessitates multiple central venous catheter placements during their early life and these children are at risk of catheter related veno-occlusive disease. Recurrent sepsis and the loss of satisfactory venous access for the administration of parenteral nutrition is life threatening and is an indication for intestinal transplantation in up to 41% of patients reported by the small bowel registry.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Haemoptysis as a late complication of a Mustard operation treated by balloon dilation of a superior caval venous obstruction.Haemoptysis was the presenting symptom in a 27-year-old male. He had undergone a Mustard operation for connection of complete transposition at the age of 2 years. For 6 months prior to admission, he had complained of dyspnoea without chestpain, and swelling of the fingers during hard physical work. Chest radiography and computer tomographic scans showed normal features of the pulmonary parenchyma, and no sign of cardiomegaly or vascular stasis. Fiberoptic bronchoscopy demonstrated a blood clot in the upper right bronchus, without any associated abnormalities of the bronchial tree. Doppler echocardiography showed obstruction of the superior caval vein, which was verified by cardiac catheterization. Balloon dilation at the site of obstruction increased the diameter of the vein from 0.5 to 1.7 cm, and the mean pressure in the superior caval vein was reduced significantly from 18 to 10 mmHg. The haemoptysis did not recur, and no complaints of dyspnoea or swelling of fingers during physical activity was reported 2 years later. Transthoracic echocardiography undertaken at this time revealed no obstruction of the superior caval vein. We conclude that hemoptysis is a rare complication of increased venous pressure in the upper body of patients with superior caval venous obstruction, which can be treated by balloon dilation or stenting.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/5. Left ventricular pseudoaneurysm causing superior vena caval obstruction and effusive-constrictive pericarditis.A diabetic woman with a silent myocardial infarction on clinical and electrocardiographic criteria presented with findings on physical examination of superior vena caval obstruction and effusive-constrictive pericarditis. A left ventricular posterior wall pseudoaneurysm and intrapericardial hematoma were found, with extrinsic compression of the right atrium. The diagnosis was first suspected by radionuclide imaging and confirmed by contrast angiography and surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Acute superior vena caval syndrome with airway obstruction following elective mediastinoscopy.A 47-year-old female patient had a subclinical superior vena caval syndrome which developed into the 'full blown' acute condition when she was placed into the left lateral position after mediastinoscopy. She developed airway obstruction requiring urgent re-intubation and subsequent admission to the intensive care unit. This subclinical condition might have been suspected pre-operatively if closer attention had been paid to the history, physical examination and review of the computerised axial tomography scan: she had a history of intermittent dysponea, wheeze and cough which was worse on waking and improved as the day progressed, she had a positive Pemberton's sign and the computerised axial tomography scan showed that the lesion was encroaching on the superior vena cava.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. A case of superior vena cava syndrome caused by klebsiella pneumoniae.A 27 yr old man presented with productive cough, fever and manifestations of superior vena cava syndrome. He was an alcoholic but had been in good health until 3 days prior to admission. The physical examination, the chest radiograph and the results of the sputum culture were compatible with klebsiella pneumoniae pneumonia of the right upper lobe. The superior vena cava scintigram using technetium-99m showed near total occlusion of the superior vena cava, while sputum cytology, chest computed tomography, and bronchoscopy were all negative for malignant aetiology. Antibiotic therapy brought about slow resolution of the pneumonia and also of the superior vena caval obstruction. The follow-up scintigram showed normalized venous flow of the superior vena cava. To our knowledge, this is the first case of superior vena cava syndrome developed in probable association with klebsiella pneumoniae pneumonia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |