Abstract
Rationale: Promptly obtaining a diagnosis is crucial in the management of patients with superior vena cava syndrome (SVCS) but endoscopic procedures in this population have not been well studied.
Methods: We reviewed all patients presenting with a SVCS and referred for endoscopic procedures in our center over 5 years.
Results: Forty-three patients underwent 64 procedures, including 23 EBUS. Most patients had a malignant diagnosis (93%). Twelve (19%) patients had a SVCS severity score > 3/4 and 22 (40%) had central airway obstruction > 50%. Diagnostic yield of standard bronchoscopy and EBUS were respectively 81.3% and 87.0%.
Minor complications were reported in 8 (13%) procedures, consisting of 4 (6%) bleedings requiring topical treatments and 6 (9%) transient hypoxemias extending more than an hour after the procedure. Three patients had major complications, including a tension pneumothorax during positive pressure ventilation in a patient with a tracheoesophageal fistula, an emergent cricotomy in a patient with a tracheal tumor who could not be ventilated or intubated after induction of general anesthesia and unstable atrial fibrillation in a patient with a neoplastic pericardial effusion. Type of procedure, SVCS severity or presence of significant central airway obstruction were not associated with more frequent complications.
Conclusions: Endoscopic procedures have a good diagnostic yield in patients with SVCS. Minor complications were not uncommon but did not alter patient trajectory. We feel that major complications in our cohort were not related to the SVCS, but rather to the underlying malignancy and its proximity to central vital structures. These factors must be considered when selecting diagnostic tests.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 2925.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020