Thrombogenic Catheter-Associated Superior Vena Cava Syndrome

Superior vena cava syndrome has historically been associated with malignancy. With the increasing use of indwelling central lines, catheters, and pacemakers in the past decade, there have been an increasing number of cases associated with thrombosis rather than by direct external compression. Patients presenting to the ED with an acute process of SVC syndrome need to be assessed in a timely fashion. Computed tomography angiography (CTA) or magnetic resonance angiogram (MRA) are superb modalities for diagnosis and can quickly be used in the ED. Treatment is oriented towards the underlying cause of the syndrome. In cases of thrombogenic catheter-associated SVC syndrome, anticoagulation is the mainstay of treatment. We present a case report and discussion of a 56-year-old male with a history of metastatic colorectal cancer and an indwelling central venous port with acute signs and symptoms of superior vena cava syndrome. 1. Introduction Superior vena cava (SVC) syndrome occurs when there is direct compression or obstruction of the superior vena cava. It is usually associated with a benign gradual increase of symptoms; however, in more acute scenarios, it can be life threatening. SVC syndrome is associated with malignancies like nonsmall-cell lung cancer, small-cell lung cancer, lymphoma, and metastatic lesions, which account for most cases [1]. Infections, such as tuberculosis, syphilis, histoplasmosis, and actinomycosis, have also been reported to cause this syndrome. Other causes include mediastinal fibrosis, vascular diseases, stenosis, and thrombosis. Clot-related SVC syndromes are generally more acute and are typically associated with central venous catheters and pacemaker leads. The increased use of indwelling lines and pacemakers in recent years has also yielded more cases of SVC syndrome overall. One report states that nonmalignant causes of SVC syndrome may represent up to 40% of cases [2]. It is important to consider causes other than direct compression by tumors, especially in more acute cases of SVC syndrome. 2. Case Presentation A 56-year-old Caucasian male presented to community emergency department with dyspnea, headache, chest congestion, and sore throat. The patient was recently diagnosed with metastatic colon cancer 2 months prior to his presentation in the ED, and he was currently undergoing chemotherapy. He had a right central venous access port placed one month before the onset of his symptoms. A CT scan of the chest was obtained and revealed a thrombus extending from the internal jugular to the right atrium (Figure 1). Patient was