title: Massive thrombosis of brachiocephalic veins and superior vena cava syndrome in a patient with non-small cell lung cancer treated with the epidermal growth factor receptor inhibitor erlotinib.
abstract: The superior vena cava (SVC) syndrome occurs when obstruction of this vessel interrupts venous return of blood from the head, upper extremities and thorax to the right atrium. Most cases of SVC syndrome result from neoplasia, especially from lung cancer, but other non-cancer-associated causes may include fibrosis caused by radiotherapy, collagen-vascular diseases, arteriovenous shunts or thrombosis as a complication of use of central venous catheters or devices. We report here the case of a 60-year-old woman with non-small cell lung cancer who was treated, after three lines of chemotherapy, with the epidermal growth factor receptor inhibitor erlotinib and subsequently presented to the hospital with abrupt onset of syncope, shortness of breath and cyanosis (face, neck and trunk). A CT scan of the chest demonstrated a massive thrombosis of both brachiocephalic veins and the SVC. The patient was treated with the systemic thrombolytic agent urokinase, with resolution of the clinical picture and no bleeding complications. The possible pathogenetic causes of thrombosis of the brachiocephalic veins and SVC syndrome in this case are discussed. It is possible that acute thrombosis may be associated with erlotinib use, even if it is likely that cancer may be the main cause of the thrombotic complication.
authors.affiliation: Department of High Rotation Internal Medicine, St Anna General Hospital, Ferrara, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Salmi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gaudenzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Di Todaro
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Morandi
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nielsen
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016121:Brachiocephalic Veins; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000188:drug therapy*; D003490:Cyanosis / Q000209:etiology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D011799:Quinazolines / Q000627:therapeutic use*; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D013575:Syncope / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors