Abstract
Purpose: An unusual case of superior vena cava (SVC) syndrome caused by an infected right atrial-SVC junction thrombus may be diagnosed using transesophageal echocardiography.
Clinical features: A 59-yr-old male with end-stage renal disease requiring hemodialysis presented with fungemia and later developed facial and bilateral upper extremity edema. Transesophageal echocardiography revealed subtotal occlusion of the SVC at its junction with the right atrium. The mass was surgically removed with cardiopulmonary bypass support. Pathological examination of the mass confirmed the presence of a large fungal colony ofCandida species mixed in the thrombus. The patient’s signs and symptoms of SVC obstruction resolved, and he was discharged from the hospital four weeks later in stable condition.
Conclusion: Although usually caused by extrinsic tumour compression, SVC syndrome can result from intravascular caval obstruction. This etiology should also be considered in the differential diagnosis, particularly in patients with intravascular devices. Transesophageal echocardiography is a valuable diagnostic tool in these cases.
Résumé
Objectif: Un cas inhabituel de syndrome de la veine cave supérieure provoqué par un thrombus infecté à la jonction de l’oreillette droite et de la veine cave supérieure peut être dépisté grâce à l’échocardiographie transoesophagienne.
Éléments cliniques: Un homme de 59 ans souffrant d’insuffisance rénale terminale et nécessitant une hémodialyse a manifesté une septicémie à champignons, puis un oedème facial et bilatéral des membres supérieurs. L’échocardiographie transoesophagienne a révélé une occlusion sous-totale de la veine cave supérieure à sa jonction avec l’oreillette droite. Une excision chirurgicale de la masse sous circulation extracorporelle a pu être réalisée. L’examen pathologique de la masse a confirmé la présence d’une importante colonie fongique de l’espèce Candida dans le thrombus. Les signes et symptômes d’obstruction de la veine cave supérieure ont disparu, et le patient a reçu son congé de l’hôpital quatre semaines plus tard, dans un état stable.
Conclusion: Bien que généralement causé par une compression tumorale extrinsèque, le syndrome de la veine cave supérieure peut être provoqué par une obstruction intravasculaire de la veine cave. Cette étiologie devrait faire partie du diagnostic différentiel, tout particulièrement chez les patients dotés d’appareils intravasculaires. L’échocardiographie transoesophagienne constitue un outil diagnostic précieux dans de tels cas.
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Conflicts of interest: None declared.
The work presented in this manuscript was performed at the Veterans Affairs Medical Center, Durham, North Carolina.
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Barbeito, A., Bar-Yosef, S., Lowe, J.E. et al. Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography. Can J Anesth 55, 774–778 (2008). https://doi.org/10.1007/BF03016351
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DOI: https://doi.org/10.1007/BF03016351