Superior Vena Cava Syndrome

Abstract

RECENTLY we observed a case of superior vena cava syndrome which resulted from a dissecting aneurysm of the thoracic aorta. This unusual combination of vascular lesions prompted us to review the autopsy files of the Rhode Island Hospital. In the period 1932-1951, a total of 7,006 autopsies were performed. Dissecting aneurysm of the aorta was encountered in 25 cases, an incidence of 0.35%. In none of these was there superior vena cava obstruction. A review of the literature disclosed that in only one other instance has such an entity been described.1 We wish to report the second such case, which clearly demonstrated simple obstruction of the superior vena cava. In addition, we wish to present one of two cases of aorticocaval communication treated at the Rhode Island Hospital and to differentiate between this condition and simple obstruction of the superior vena cava. REPORT OF CASESCase 1.\p=m-\E. M., a 41-year-old white man, was admitted to the Rhode Island Hospital on Nov. 6, 1952, because of extreme cyanosis involving the head, arms, and upper part of the chest. Two days prior to admission, while walking down a flight of stairs at his home, he experienced sudden severe substernal pain radiating down the middle of the body to the level of the umbilicus. This episode was followed by syncope. The patient was carried back upstairs and shortly after¬ wards was admitted to the psychiatric ward of the Charles V. Chapin Hospital, because it was thought that he was suffering from alcoholism. At that institution a presumptive diagnosis of superior vena cava obstruction was made, and the patient was transferred to the Rhode Island Hospital for further care.Past History.-The patient was studied at the Lahey Clinic in 1946 because of a neurological disorder. It was thought at that time that he probably had widespread disseminated sclerosis.Physical Examination.-The temperature was 100.8 F., pulse rate 120, respiration 28, blood pressure 125/96 (left arm) and 130/90 (right arm). The'patient was a well-developed wellnourished man lying quietly in bed in moderate respiratory distress. The skin was a striking reddish-blue in both upper extremities and the neck, chest, head, and face. The veins of the neck and arms were obviously engorged. The skin was edematous in the upper portions of the body. No rash or ulcers were noted. The lips were cyanotic. The conjunctivae were slightly injected. The pupils were round, regular, and equal and reacted to light and accommodation. The fundi revealed normal discs with no hemorrhages or exudates. The tongue was dry and well papillated. The carotid pulsations in the neck were easily palpable. The lungs were clear to auscultation and percussion. No widening of the mediastinum could be demonstrated by percussion. The heart was normal in size, with normal sinus rhythm. No murmur or thrill could be detected on careful examination of the right anterior chest, sternum, and precordium.