PDF(Pubmed)
Abstract：
Superior vena cava (SVC) thrombus is a rare but potentially life-threatening condition where a blood clot forms in the superior vena cava, the vein carrying blood from the head, neck, and upper extremities to the heart. The incidence of SVC thrombosis is higher in patients with certain underlying medical conditions, such as malignancy, heart failure, and chronic obstructive pulmonary disease. In this case study, a 36-year-old African American female with a history of essential hypertension, type 2 diabetes, end-stage renal disease, anemia of chronic disease, obstructive sleep apnea, obesity, and preeclampsia presented with sudden onset of confusion six days postpartum. The patient was admitted for further evaluation and treatment. Imaging tests showed an acute infarct in the left parietal lobe with no intracranial hemorrhage and an echo density/mass in the SVC consistent with a thrombus. Risk factors for SVC thrombus included pregnancy, a hypercoagulable state, and issues with catheter placement. The increasing use of intravascular devices such as indwelling catheters and pacemaker wires has been implicated in the rising incidence of SVC thrombus. Complete occlusion of the SVC is usually symptomatic and presents with a clinical picture similar to SVC syndrome. The importance of early detection and intervention was highlighted in this case, as the patient was initially asymptomatic after the onset of neurological symptoms. Treatment involved discontinuing heparin and starting the patient on Apixaban without a loading dose. This case study emphasizes the potential risk factors and complications associated with SVC thrombus and highlights the importance of early detection and intervention.
摘要：
上腔静脉（SVC）血栓是一种罕见但可能危及生命的疾病，在上腔静脉中形成血凝块，从头部携带血液的静脉，脖子,和上肢到心脏。SVC血栓形成的发生率在某些潜在的医疗条件的患者较高，比如恶性肿瘤，心力衰竭,和慢性阻塞性肺疾病。在这个案例研究中,一名36岁的非裔美国女性，有原发性高血压病史，2型糖尿病,终末期肾病,慢性病贫血，阻塞性睡眠呼吸暂停,肥胖，先兆子痫表现为产后6天突然出现意识模糊。患者入院接受进一步评估和治疗。影像学检查显示左顶叶急性梗塞，无颅内出血，SVC回声密度/肿块与血栓一致。SVC血栓的危险因素包括妊娠，高凝状态,和导管放置的问题。血管内装置如留置导管和起搏器导线的使用越来越多地与SVC血栓的发生率上升有关。SVC的完全闭塞通常是有症状的，并且表现出类似于SVC综合征的临床表现。在这种情况下，强调了早期发现和干预的重要性，因为患者在出现神经症状后最初无症状。治疗包括停用肝素，并在不使用负荷剂量的情况下开始接受阿哌沙班治疗。本案例研究强调了与SVC血栓相关的潜在危险因素和并发症，并强调了早期发现和干预的重要性。
