PDF(Pubmed)
Abstract：
The superior vena cava syndrome (SVCS) has been frequently reported to be secondary to malignancy, specifically, small cell bronchogenic carcinoma and non-Hodgkin\'s lymphoma. There is some data suggesting causes like postprocedural hematomas. We aim to describe a case of a patient who developed SVCS secondary to a mediastinal hematoma secondary to epicardial pacer leads (postprocedural). Our case is about a 75-year-old male with a past medical history of coronary artery disease and coronary artery bypass graft (CABG) who presented to the Emergency Department (ED) with moderate-to-severe right axillary pain radiating to the ipsilateral side of the neck, arm, and chest, associated to right temporal headache. A computed tomography angiography (CTA) of the chest was indicated at the time and revealed a hematoma with an active extravasation within the right superior anterior mediastinum, outside the pericardium. The patient was admitted to the Cardiovascular Intensive Care Unit (CVICU) and was started on nicardipine as his blood pressure in the ED was 217/125 and remained elevated despite proper pain management. A repeat CT scan of the chest showed a regressing hematoma that coincided with an improvement of the symptoms. This case highlights the importance of the complications of anterior mediastinal hematoma. The superior vena cava syndrome can develop after cardiologic procedures, after the implantation of devices. Prompt clinical diagnosis, including imaging, and treatment are necessary to manage this condition.
摘要：
上腔静脉综合征（SVCS）经常被报道为继发于恶性肿瘤，具体来说,小细胞支气管癌和非霍奇金淋巴瘤。有一些数据表明像术后血肿这样的原因。我们的目的是描述一例继发于心外膜起搏器导线（术后）的纵隔血肿继发的SVCS患者。我们的病例是关于一名75岁的男性，有冠状动脉疾病和冠状动脉搭桥术（CABG）的既往病史，他向急诊科（ED）就诊，患有中度至重度右腋窝疼痛，手臂,和胸部，与右侧颞部头痛有关。当时有胸部计算机断层扫描血管造影（CTA），并显示右上纵隔内血肿伴活动性外渗，心包外.患者入院心血管重症监护病房（CVICU），并开始服用尼卡地平，因为他在ED中的血压为217/125，尽管进行了适当的疼痛管理，但仍保持升高。胸部重复CT扫描显示血肿消退，症状改善。此病例强调了前纵隔血肿并发症的重要性。上腔静脉综合征可在心脏手术后发展，植入装置后。及时的临床诊断，包括成像，和治疗是必要的，以管理这种情况。
