CASE 159 Published on 20.12.2001
0

Percutaneous stenting in superior vena cava syndrome

Section

Interventional radiology

Case Type

Clinical Cases

Authors

Bassetti E., Mangiapane F., Iafrate F., Marcelli G.,Rossi P

Connected authors
Patient

59 years, female

Categories
No Area of Interest ; Imaging Technique MR
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Clinical History
Patient presented himself on April 1993 with fever, dry cough, haematemesis. Thorax-MR showed a mass (4.6 x 5.3 cm) at the right anterior-superior mediastinum. The superior vena cava (SVC) was compressed. Two self-expandable stents were placed in SVC and in the left brachiocephalic trunk.
Imaging Findings
The patient presented himself on April 1993 with fever, dry cough, haematemesis. Bronchoscopy was performed with evidence of pulmunar microcitoma. On January 1999 a Thorax-MR showed a mass (4.6 x 5.3 cm) at the right anterior-superior mediastinum. The superior vena cava (SVC) was compressed and infiltrated at the confluence of the two brachiocephalic trunks. The SVC flebography confirmed the strictures of the SVC and the left brachiocephalic trunk. Therefore two "kissing" metallic self-expandable stents were placed in SVC and in the left brachiocephalic trunk. The final flebography showed good flow through the stent of the right side,and a residual and no significant stenosis on the left side.
Discussion
We decided to place metallic stents to mantain the patency of the vessels. Self-expandable metallic stents are raccomended because of their high radial force. The two stents were dilatated with a 10 mm balloon catheter, to garanty a complete dilatation of the strictures; anticoagulant drugs were administred to prevent a new stenosis. It is also true that in some cases the only opening of one central vein is most sufficient to treat symptomps. Periodic CT scan were performed for the follow-up.
Differential Diagnosis List
Mediastinic syndrome with compression of SVC and left brachiocephalic trunk.
Final Diagnosis
Mediastinic syndrome with compression of SVC and left brachiocephalic trunk.
Case information
URL: https://eurorad.org/case/159
DOI: 10.1594/EURORAD/CASE.159
ISSN: 1563-4086
Figure 1

T1 weighted MR image after contrast media

T1 weighted MR image after contrast media
The image shows a mass (4.6 x 5.3 cm) at the right anterior-superior mediastinum. The superior vena cava (SVC) was compressed and infiltrated at the confluence of the two brachiocephalic trunks.
Figure 2

Superior Vena Cava flebografy

Superior Vena Cava flebografy
Strictures of the SVC and the left brachiocephalic trunk.
Figure 3

Superior Vena Cava flebografy

Superior Vena Cava flebografy
A 10 mm balloon was use to garanty a complete dilatation of the strictures.
Figure 4

Final flebography

Final flebography
The final flebography shows good flow through both stents.