This came up in Question 25 from the second paper of 2005.
Generally speaking - on the basis of statistics - the cause of obstruction is almost invariably malignant. The mean life expectancy in these people is about 6 months even with treatment, but it can be variable depending on precisely which malignancy is involved.
Type of SVC obstruction |
Aetiology |
Diagnosis |
Management |
Malignant |
Malignant mass in thoracic inlet |
History (eg. smoking) |
Surgical excision |
Non-malignant |
Tuberculosis |
Suspicious history, CT, CXR, aspiration and AFB/ZN stain/PCR of the contents |
Specific antituberculosis therapy |
Abscess |
CT, CXR, aspiration and gram stain / culture of the contents |
Surgical drainage |
|
Goitre |
CXR, CT, TFTs, biopsy of the mass |
Surgical excision |
|
Thrombus |
History of IJ CVC |
Antioagulation; clot retrieval by interventinal radiology procedure, or surgical embolectomy |
|
Fibrosing mediastinitis |
CT; |
Surgical relief of obstruction |
|
Aortic aneurysm |
Ct with contrast; TOE |
Surgical management of aneurysm; |
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