Diffuse Lung Disease |

Successful Angioplasty and Stenting for Superior Vena Cava Syndrome in Sarcoidosis FREE TO VIEW

Abdel Rahman Lataifeh, MD; Rajani Jagana, MD; Manish Joshi, MD
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University of Arkansas for Medical Sciences, Little Rock, AR

Chest. 2014;146(4_MeetingAbstracts):388A. doi:10.1378/chest.1992570
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SESSION TITLE: Interstitial Lung Disease Cases I

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 26, 2014 at 03:15 PM - 04:15 PM

INTRODUCTION: Super Vena Cava (SVC) Syndrome is a clinical condition that results from obstruction of blood flow in the SVC. While the majority of cases (75%) are malignancy-related, it is estimated that the incidence of SVC syndrome due to benign diseases have increased recently because of the excessive use of central venous catheters. These benign diseases include fibrosing mediastinitis,aortic aneurysms,histopalsmosis and sarcoidosis. We present a case of sarcoidosis-related SVC syndrome treated successfully with SVC angioplasty and stenting

CASE PRESENTATION: A 41-year-old African American woman was initially evaluated in 2003 for cervical, axillary and hilar lymphadenopathy without respiratory symptoms. Excisional lymph node biopsy confirmed the diagnosis of sarcoidosis. Over the next few years patient developed dyspnea, cough and lung infiltrates. Despite receiving long term systemic steroids, her pulmonary disease deteriorated progressively resulting in hypoxemic respiratory failure due to lung fibrosis. In 2009, she presented with worsening dyspnea, facial swelling and dilated veins on the anterior chest. Chest CT showed complete obstruction of the SVC with confluent soft tissue density noted within the mediastinum and both hila representing constellation of enlarged lymph nodes. The patient was treated successfully with balloon angioplasty and SVC stenting with improvement in her symptoms. Three years later, she had a recurrence of SVC syndrome due to stent stenosis for which she underwent a successful balloon angioplasty. The patient has had radiological and clinical follow up until the present time with no recurrence of SVC syndrome

DISCUSSION: SVC syndrome is a very rare complication of sarcoidosis. We found a total of eleven previous case reports in the literature. While Steroids were predominantly used in most cases, one case report documented the use of saphenous venous grafting. We elected to use SVC stenting in our patient as her disease had progressed despite chronic steroid therapy and her respiratory status was poor. Young patients with SVCS due to benign diseases need to have an effective and durable treatment modality like saphenous venous graft. Recently some institutions started to adopt SVC angioplasty with stenting for benign SVC syndrome

CONCLUSIONS: To the best of our knowledge, this is the first reported case in the English literature of Sarcoidosis-related SVC syndrome treated with angioplasty and stenting

Reference #1: Narayan et al,.Surgical management of SVC syndrome in sarcoidosis Ann Thorac Surg

DISCLOSURE: The following authors have nothing to disclose: Abdel Rahman Lataifeh, Rajani Jagana, Manish Joshi

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