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SVC syndrome and pancoast tumor

Discussion in 'Step I' started by yoyohomieg5432, May 30, 2016.

  1. yoyohomieg5432

    5+ Year Member

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    I'm kind of confused about pancoast tumor and what it causes. FA says it's a common cause of SVC syndrome, but there was a related UW question, i picked pancoast and it was wrong. Their answer was mediastinal mass. (UW #565). What tumors cause mediastinal mass? I can just think of like T cell lymphoma or maybe other types of lymphomas.

    What does pancoast tumor cause then if SVC syndrome isn't very common? I know about horner's.
     
  2. StraightOuttaBrooklyn

    StraightOuttaBrooklyn Future House, M.D.

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    I studied the hell out of this today so I can take a stab at this

    SVC can be caused by a pancoast tumor OR a mediastinal mass

    Pancoast tumor (mass at the apex of the lung) is commonly referred to as "superior sulcus tumor" because a mass at the lung apex will have a mass-compression effect in between the subclavian vessels.

    If you have a right sided apical mass that is large enough it may compress the superior aspects of the SVC (i.e., not in the proximity of where the SVC meets the RA in the mediastinum); in that case, you have an obstruction to venous drainage of the head, neck, and both arms because SVC is the outlet for all that.

    If you have a right or left sided apical mass (pancoast tumor/superior sulcus tumor) of a more modest size, then it is more likely going to produce an ipsilateral horner syndrome or compression/invasion of the brachial plexus, causing frank deficits in the distribution of the brachial plexus.


    If you have a mediastinal mass: the SVC meets the RA within the mediastinum; the heart is a mediastinal structure. If you have a mass in the mediastinum that is compressing the SVC, then you will haven an obstruction to venous drainage of the head, neck, and both arms because SVC, again, is the common venous drainage outlet for those structures.

    Finally, if you have a brachiocephalic vein compression (keep in mind that the SVC is formed by the union of the right and left brachiocephalic) you basically get a "1/2" of a SVC syndrome - if the left BC vein is compressed, you'll have the symptoms only on the left (left sided plethora, flushing, etc); likewise, if the right is compressed, symptoms look like a right-sided SVC syndrome.

    TL;DR - Mediastinal Masses = can cause SVC syndrome. Apical masses more likely to cause ipsilateral Horner syndrome & brachial plexus defects, but if on the right side and large enough, may cause SVC syndrome.
     
  3. recycledpaper

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    If it's just SVC syndrome and mediastinal mass is an answer, pick it.

    If it's SVC syndrome with concomitant Horner's, and both pancoast and mediastinal mass are answers, pick pancoast.
     
  4. OP
    OP
    yoyohomieg5432

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    fantastic, thank you!
     
  5. samara13

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    Other than what's been written here, you need to focus on the clinical vignette..
    if its a young patient then its lymphoma not usually pancoast tumor.. lymphoma can be a mediastinal mass.
    but if its an old person then its pancoast tumor because lung cancer is the commonest in elderly.
    SVC syndrome can be caused by indwelling catheter or from thrombosis so it depends on whats the clinical picture and investigations of the case presented
     
    iBS1972 likes this.
  6. usmlematerialsnet

    usmlematerialsnet usmlematerials.net

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    If it's just SVC syndrome and mediastinal mass is an answer, pick it.
     
  7. PoomMD

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    All i know that if the SVCs occur in the young age patient it might be from germ cell tumor which is teratoma you have to confirm by AFP and beta hCG
     

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