title: Early thrombosis of the superior vena cava in a patient with a central venous catheter and carcinoma of the ampulla of Vater.
abstract: Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. The diagnosis is suggested by the clinical manifestations of facial and upper extremity swelling, dyspnea, and cough. It is confirmed by CT scan showing the development of collateral flow around the lesion. In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.
authors.affiliation: Veterans Administration Medical Center, Augusta, Georgia, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Cannon
authors.forename: Malay
authors.initials: M
authors.lastname: Shah
authors.forename: Erin
authors.initials: E
authors.lastname: Suydam
authors.forename: Angela
authors.initials: A
authors.lastname: Gucwa
authors.forename: Talmadge
authors.initials: T
authors.lastname: Bowden
authors.forename: Steven B
authors.initials: SB
authors.lastname: Holsten
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000473:pathology / Q000628:therapy; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014683:Vena Cava, Superior / Q000473:pathology*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy