deep venous thrombosis Archives - Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

SVC Obstruction

Codeholic Admin — Mon, 13 Mar 2017 16:55:08 +0000

SVC Obstruction

SVC obstruction is a narrowing or blockage of the superior vena cava, which is the second largest vein in the human body. The superior vena cava moves blood from the upper half of the body to the heart.

Causes

Superior vena cava (SVC) obstruction is a relatively rare condition.

It is most often caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs).

The types of cancer that can lead to this condition include:

Breast cancer
Lymphoma
Metastatic lung cancer (lung cancer that spreads)
Testicular cancer
Thyroid cancer
Thymus tumor

Superior vena cava obstruction can also be caused by noncancerous conditions that cause scarring. These conditions include:

Histoplasmosis (a type of fungal infection)
Inflammation of a vein (thrombophlebitis)
Lung infections (such as tuberculosis)

Other causes of superior vena cava obstruction include:

Aortic aneurysm (a widening of the artery that leaves the heart)
Blood clots in the superior vena cava
Constrictive pericarditis (tightening of the thin lining of the heart)
Effects of radiation therapy for certain medical conditions
Enlargement of the thyroid gland (goiter)
Catheters placed in the large veins of the upper arm and neck may cause blood clots in the superior vena cava.

Symptoms

Symptoms occur when something blocks the blood flowing back to the heart. They may begin suddenly or gradually, and may worsen when you bend over or lie down.

Early signs include:

Swelling around the eye
Swelling of the face
Swelling of the whites of the eyes
The swelling will most likely be worse in the early morning hours and go away by mid-morning.

The most common symptoms are shortness of breath (dyspnea) and swelling of the face, neck, trunk, and arms.

Other possible symptoms include:

Decreased alertness
Dizziness
Fainting
Headache
Reddish face or cheeks
Reddish palms
Reddish mucus membranes (inside the nose, mouth, and other places)
Redness changing to blueness later
Sensation of head or ear “fullness”
Vision changes

Exams and Tests

An examination may show enlarged veins of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.

A bronchoscopy (a lighted tube placed through the mouth into the windpipe and lungs) may be performed if lung cancer is suspected.

Blockage of the SVC may be visible on:

Chest x-ray
CT scan of the chest or MRI of chest
Coronary angiography (a heart blood vessel study)
Doppler ultrasound (sound wave test of the blood vessels)
Radionuclide ventriculography (nuclear study of heart motion)

This disease may also affect the results of the following tests:

Abdominal MRI or CT scan
Liver scan

Treatment

The goal of treatment is to relieve the blockage.

Diuretics (water pills) or steroids may be used to temporarily relieve swelling.

Other treatment options may include radiation or chemotherapy to shrink the tumor, or surgery to remove the tumors. A minimally invasive option is placement of a stent to open up the SVC. This is performed by a vascular and interventional radiologist. Surgery to bypass the obstruction is rarely performed.

Outlook (Prognosis)

The outcome varies, depending on the cause and the amount of blockage.

SVC syndrome caused by a tumor is a sign that the tumor has spread, and it indicates a poorer long-term outlook.

Possible Complications
The throat could become blocked, which can block the airways.

Increased pressure may develop in the brain, leading to changed levels of consciousness, nausea, vomiting, or vision changes.

When to Contact a Medical Professional
Call your health care provider if you develop symptoms of SVC obstruction. Complications are serious and can sometimes be fatal.

Prevention

Prompt treatment of other medical disorders may reduce the risk of developing SVC obstruction.

Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome

References

Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42. PMID: 16523051 www.ncbi.nlm.nih.gov/pubmed/16523051.

Ugras-Rey SS. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 123.

Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-9. PMID: 17476012 www.ncbi.nlm.nih.gov/pubmed/17476012.

Review Date 1/13/2015
Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

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May-Thurner Syndrome

Codeholic Admin — Mon, 13 Mar 2017 16:54:49 +0000

May-Thurner Syndrome

May-Thurner syndrome is a rare vascular condition that affects a vein in the pelvis.

It occurs when a nearby artery compresses the left iliac vein. This vein brings blood from your pelvis and legs back up to your heart.

The compression prevents blood from flowing properly, leading to narrowing and scarring.

In some cases, an artery can compress the right iliac vein, or both veins.

Complications

Some people with May-Thurner syndrome have no symptoms, but over time, this condition can lead to:

Leg swelling.

Chronic venous insufficiency, in which blood pools in your veins. This causes swelling, pressure, skin changes, and venous ulcers or sores that don’t heal.

Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin. If a blood clot breaks free and travels to your lungs, heart, or brain, it can lead to serious, even life-threatening issues like: Pulmonary embolism, a blood clot in your lung, Heart attack or Stroke.

Symptoms

Swelling, heaviness, or fullness in your leg or foot.
Venous ulcers or sores that do not heal on your leg.
Varicose veins in your leg.
In some cases, May-Thurner syndrome has no symptoms and patients go undiagnosed until they develop deep vein thrombosis (DVT).

Symptoms of DVT can include:

Leg swelling.
Leg pain and tenderness.
Redness or other changes in skin color.
Skin that feels warm.

Diagnosis

To diagnose May-Thurner syndrome, your doctor will:

Perform a physical exam.
Ask about your medical history and symptoms.
Use an imaging test — like an ultrasound, MRI, or venogram — to confirm your diagnosis.

Treatment

If symptoms are severe, this would warrant placement of a stent in the affected vein which would displace the pressure that caused the narrowing. This is performed by a vascular & interventional radiologist.

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Deep Venous Thrombosis (DVT)

Codeholic Admin — Mon, 13 Mar 2017 16:53:56 +0000

Deep Venous Thrombosis (DVT)

Deep Vein Thrombosis

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.

Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.

A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus. It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism, or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.

Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots also can form in veins closer to the skin’s surface. However, these clots won’t break off and cause PE.

Diagnosis

DVT in the legs and arms can easily and quickly be diagnosed by ultrasound. Pulmonary embolism is readily detected by a CT angiogram of the lungs.

Symptoms

Symptoms of DVT in the leg include:

Swelling
Pain
Redness
Warmth to the touch
Worsening pain when bending the foot
Leg cramps (especially at night and/or in the calf)
Discoloration of skin

Treatment

Treatment of DVT in the leg is individualized for each patient. Usually, anticoagulation or blood-thinning medication is prescribed to prevent further clot formation and to minimize the risk that part of the blood clot will break off and travel to the lung.

When symptoms are severe and there is a large amount of thrombus, treatment may include placement of an IVC filter. This filter prevent blood clots from traveling to the lung. Additionally, an interventional radiologist can perform thrombectomy or thrombolysis. This minimally invasive procedure removes the clot or uses medications to break it down.

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