SESSION TYPE: Bronchology Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Thoracic tumors are a common cause of SVC syndrome. The mass can cause complete or partial obstruction of the vessel lumen. The most common malignancies known to cause this syndrome are of bronchogenic origin. Because of the distension and back pressure caused by the tumor occluding the superior vena cava, bleeding is a feared and known complication. There has been no publication that we are aware of looking at EBUS for diagnosis of this condition.
CASE PRESENTATION: 72 year old woman with a past medical history of hypertension presented with cough, facial edema, and dyspnea to our emergency department. Patient had an extensive smoking history, more than 100pkyrs, and quit 6months ago. She also reported anorexia and weight loss. Chest radiography revealed tracheal deviation to the left and mediastinal fullness. Computerized Tomography of the chest was positive for a mediastinal mass invading the proximal part of the superior vena cava ( Fig 1), and the clinical diagnosis of SVC syndrome was made. Patient was treated with steroids. An EBUS guided needle aspiration was performed along the right paratracheal and subcarinal lymph nodes region ( Fig 2). Rapid on site evaluation by a pathologist was diagnostic for non-small cell malignancy, later confirmed as adenocarcinoma of primary pulmonary origin. Radiation therapy was instituted and the patient was discharged to home with scheduled follow-up visits. No complications were noted with the procedure.
DISCUSSION: We illustrate the safety of EBUS in a case of SVC syndrome. Prior studies were conducted on safety of blind transbronchial needle biopsies in the diagnosis of SVC syndrome with rapid on site evaluation of pathological specimen (Brundyn et al). The use of EBUS while performing the transbronchial biopsy has a dual benefit. The vessels can be identified and avoided during the biopsy procedure increasing safety, and a suitable area of the mass identified increasing yield.
CONCLUSIONS: EBUS can be performed safely in a patient with SVC syndrome, and has the potential to increase safety and yield compared to other diagnostic procedures.
1) Brundyn K, Koegelenberg CF, Diacon AH, et al.Transbronchial fine needle aspiration biopsy and rapid on-site evaluation in the setting of superior vena cava syndrome Diagn Cytopathol. 2011 Nov 18.
DISCLOSURE: The following authors have nothing to disclose: Bala Prakash, Shweta Upadhyay, Veronica Brito, Shalinee Chawla, Jonathan Ilowite
No Product/Research Disclosure InformationWinthrop University Hospital, Mineola, NY