Image in medicine
Point-of-care ultrasound in early detection of superior vena cava syndrome
Ecografía clínica en el diagnóstico precoz del síndrome de vena cava superior
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He had a history of clear cell renal carcinoma diagnosed in 2011 treated with total nephrectomy. In follow-up, extensive metastatic thyroid involvement was found 7 years later. Therefore, Sunitinib was initiated, with good initial response.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed distended vessels on the chest (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) with facial plethora, upper limb edema and voice hoarseness. A cervical point-of-care ultrasound (POCUS) showed bilateral internal jugular venous thrombosis of probable malignant etiology (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). POCUS echocardiography was also performed without relevant findings. The study was completed with a cervico-thoracic angio-CT which showed innominate vein thrombosis with extension to the superior vena cava.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The superior vena cava syndrome (SVCS) is the clinical manifestation of obstruction of blood flow in the superior vena cava, characterized by facial, neck, and/or upper extremity swelling. Most cases of SVCS are caused by thoracic malignancies, being non-small-cell lung cancer the most common cause. Renal carcinoma is characterized by atypical distant metastases, among others at the vascular level. Up to 10% of patients may have metastasis with vascular invasion of the inferior vena cava. However, there are practically no cases reported in the literature of bilateral jugular metastasis and innominate vein that conditions a SVCS.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Detection of the syndrome and early treatment is highly important because laryngeal and cerebral edema may cause sudden death. Therefore, in patients with suspected SVCS, POCUS is a safe, rapid, cost-effective tool that can improve the management and prognosis of these patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the patient.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Informed consent" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 501 "Ancho" => 1300 "Tamanyo" => 117644 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 990 "Ancho" => 1583 "Tamanyo" => 128617 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000010/v1_202005290855/S2387020620301443/v1_202005290855/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000010/v1_202005290855/S2387020620301443/v1_202005290855/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620301443?idApp=UINPBA00004N" ]
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