Abstract
Superior Vena Cava Syndrome (SVCS) refers to signs and symptoms caused by obstruction of the superior vena cava. Superior mediastinal syndrome (SMS) is the term used when SVCS coexists with obstruction of trachea. In children, a mediastinal pathology causing SVCS generally results in SMS as well, due to the limited chest volume. Hence, the two terms are often used interchangeably in children. SMS is a medical emergency that can be challenging, albeit often rewarding to manage. The common causes in a patient presenting to pediatric emergency room include non-Hodgkin lymphoma and acute lymphoblastic leukemia. Patients with SMS are at a very high risk for adverse cardio-respiratory events in case they are administered any kind of anesthetic agents, anxiolytics or sedatives. Investigations, including tissue diagnosis are desirable, though not mandatory, before initiating emergency management. The patient’s clinical condition should dictate the speed, requirement and sequence of investigations and the specific treatment. The least invasive procedure should be performed to confirm the diagnosis. As the most common cause of SMS in children is lymphoma/leukemia, the administration of systemic steroids is often the front line therapy. Diagnosis, monitoring and management of SMS in relevance to the pediatric emergency room are outlined.
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References
Fischer MJ, Rheingold SR. Oncologic emergencies. In: Pizzo PA, Poplack DG, eds. Principles and Practices of Pediatric Oncology. 6th ed. Philadelphia: Lippencott Williams and Wilkins; 2011. pp. 1125–51.
Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862–9.
Ingram L, Rivera GK, Shapiro DN. Superior vena cava syndrome associated with childhood malignancy: analysis of 24 cases. Med Pediatr Oncol. 1990;18:476–81.
Cheng S. Superior Vena Cava Syndrome: A contemporary review of a historic disease. Cardiol Rev. 2009;17:16–23.
Ricketts RR. Clinical management of anterior mediastinal tumors in children. Semin Pediatr Surg. 2001;10:161–8.
Chapman S, Nakielny R. Respiratory tract. In: Chapman S, Nakielny R, eds. Aids to Radiological Differential Diagnosis. 4th ed. London: Saunders; 2003. pp. 180–7.
Borenstein SH, Grestle T, Malkin D, Thorner P, Filler RM. The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma. J Pediatr Surg. 2000;35:973–6.
Loeffler JS, Leopold KA, Recht A, Weinstein HJ, Tarbell NJ. Emergency prebiopsy radiation for mediastinal masses. Impact on subsequent pathological diagnosis and outcome. J Clin Oncol. 1986;4:716–21.
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Jain, R., Bansal, D., Marwaha, R.K. et al. Superior Mediastinal Syndrome: Emergency Management. Indian J Pediatr 80, 55–59 (2013). https://doi.org/10.1007/s12098-012-0884-8
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DOI: https://doi.org/10.1007/s12098-012-0884-8