Superior vena cava syndrome differential diagnosis: Difference between revisions

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{{Superior vena cava syndrome}}
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==Overview==
==Overview==
Superior vena cava syndrome should be differentiated from other causes of [[dyspnea]] and [[jugular venous distention]], such as, [[cardiac tamponade]], [[chronic obstructive pulmonary disease]], [[mediastinitis]], [[pneumonia]], [[acute respiratory distress syndrome]], [[syphilis]], and [[tuberculosis]].
Superior vena cava syndrome should be differentiated from other causes of [[dyspnea]] and [[jugular venous distention]], such as, [[cardiac tamponade]], [[chronic obstructive pulmonary disease]], [[mediastinitis]], [[pneumonia]], [[acute respiratory distress syndrome]], and [[syphilis]].<ref name="pmid26458355">{{cite journal |vauthors=Menon A, Gupta A |title=Superior vena cava syndrome |journal=Indian J. Med. Res. |volume=142 |issue=3 |pages=350 |year=2015 |pmid=26458355 |pmc=4669875 |doi=10.4103/0971-5916.166606 |url=}}</ref>


==Differentiating Superior Vena Cava Syndrome from other Diseases==
==Differentiating Superior Vena Cava Syndrome from other Diseases==
In a patient with a suspected [[superior vena cava]] syndrome, the following conditions also need to be considered:
 
*[[Acute respiratory distress syndrome]]
The table below summarizes the findings that differentiate superior vena cava syndrome from other conditions that also cause  [[dyspnea]] and [[jugular venous distention]]:
*[[Cardiac tamponade]]
 
*[[Chronic obstructive pulmonary disease]]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px" align=center
*[[Mediastinitis]]
|valign=top|
*[[Pneumonia]]
|+
*[[Syphilis]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
*[[Tuberculosis]]
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | '''[[Cardiac tamponade]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension
| style="padding: 5px 5px; background: #F5F5F5;"|
*In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | '''[[Chronic obstructive pulmonary disease]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*Elevated jugular venous pulse (JVP), dyspnea, and tachypnea
| style="padding: 5px 5px; background: #F5F5F5;"|
*In COPD, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | '''[[Mediastinitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*Elevated venous pressure, tachypnea and dyspnea
| style="padding: 5px 5px; background: #F5F5F5;"|
*In mediastinitis, differentiating features include:  fever, positive confirmation of organisms, and elevated [[leukocytes]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"  | '''[[Pneumonia]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*[[Hypotension]], [[tachypnea]], [[cough]], and [[chest pain]]
| style="padding: 5px 5px; background: #F5F5F5;"|
*In pneumonia, differentiating features include:  bronchial breath sounds, [[leukocytosis]] with left shift, positive blood culture, and altered laboratory findings (eg. procalcitonin)
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"  | '''[[Acute respiratory distress syndrome]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*Low blood pressure, [[hypotension]], and [[dyspnea]]
| style="padding: 5px 5px; background: #F5F5F5;"|
*In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles, and pulmonary wedge pressure  < 18 mmHg
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | '''[[Syphilis]]'''
| style="padding: 5px 5px; background: #F5F5F5;"|
*Enlarged lymph nodes, hypotension, and dysphagia
| style="padding: 5px 5px; background: #F5F5F5;"|
*In syphilis, differentiating features include: positive [[treponemal tests]], history of unprotected sex, and superficial mucosal patches
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:33, 5 March 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Maria Fernanda Villarreal, M.D. [2]

Overview

Superior vena cava syndrome should be differentiated from other causes of dyspnea and jugular venous distention, such as, cardiac tamponade, chronic obstructive pulmonary disease, mediastinitis, pneumonia, acute respiratory distress syndrome, and syphilis.[1]

Differentiating Superior Vena Cava Syndrome from other Diseases

The table below summarizes the findings that differentiate superior vena cava syndrome from other conditions that also cause dyspnea and jugular venous distention:

Differential Diagnosis Similar Features Differentiating Features
Cardiac tamponade
  • Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension
  • In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes
Chronic obstructive pulmonary disease
  • Elevated jugular venous pulse (JVP), dyspnea, and tachypnea
  • In COPD, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%
Mediastinitis
  • Elevated venous pressure, tachypnea and dyspnea
  • In mediastinitis, differentiating features include: fever, positive confirmation of organisms, and elevated leukocytes
Pneumonia
  • In pneumonia, differentiating features include: bronchial breath sounds, leukocytosis with left shift, positive blood culture, and altered laboratory findings (eg. procalcitonin)
Acute respiratory distress syndrome
  • In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles, and pulmonary wedge pressure < 18 mmHg
Syphilis
  • Enlarged lymph nodes, hypotension, and dysphagia
  • In syphilis, differentiating features include: positive treponemal tests, history of unprotected sex, and superficial mucosal patches

References

  1. ↑ Menon A, Gupta A (2015). "Superior vena cava syndrome". Indian J. Med. Res. 142 (3): 350. doi:10.4103/0971-5916.166606. PMC 4669875. PMID 26458355.

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