Superior vena cava syndrome-induced hemoptysis

• Published in: The American journal of the medical sciences Vol. 365; no. 2; p. 205
• Main Authors: Al Saadi, Waleed, Al Khalili, Huda, Al Hajriy, Mahmood
• Format: Journal Article
• Language: English
• Published: United States 01.02.2023
• Subjects: Adult; Hemoptysis - complications; Humans; Kidney Failure, Chronic - complications; Male; Renal Dialysis - adverse effects; Superior Vena Cava Syndrome - diagnostic imaging; Superior Vena Cava Syndrome - etiology; Superior Vena Cava Syndrome - pathology; Vena Cava, Superior - pathology
• ISSN: 1538-2990
• DOI: 10.1016/j.amjms.2022.07.021

Superior vena cava (SVC) syndrome resulting from obstruction of the blood flow to the superior vena cava is rarely reported to present with life-threatening hemoptysis. The pathogenesis and the underlying mechanism are still not well described in the literature. We report a unique case of a 27-year-old man known to have end-stage kidney disease (ESKD) on hemodialysis that presented with shortness of breath and life-threatening hemoptysis that developed during the dialysis session. Computerized tomography with contrast (CTPA) confirmed the presence of a large, calcified thrombus within the SVC along with the formation of multiple collaterals which was diagnostic for SVC syndrome. Attempts for revascularization and stenting failed, and the patient had a prolonged and stormy course while admitted, including difficult alternative dialysis access that unfortunately resulted in death eventually. Here we are highlighting the importance of recognition of hemoptysis as a presentation of SVC syndrome by explaining the underlying pathogenesis and possible management options.