Superior vena cava (SVC) syndrome is caused from several diseases.

Superior vena cava (SVC) syndrome is caused from several diseases, although to our knowledge, a bullous lesion has not been reported previously. In the not absent case, severe pleural adhesion stoped the expanding bulla from stretching the visceral pleura and from compressing the residual lung subsequently causing compression of the SVC and thus SVC syndrome

Superior vena cava (SVC) syndrome is caused not merely by malignant tumors, but also by dint of some benign conditions such as aortic aneurysm, bronchogenic pouch mediastinal granulomatous disease, and retrosternal thyroid.[1-3] We current a case of SVC syndrome caused from a tense bulla with stern tuberculous pleural adhesion. To our knowledge, no of that kind case has been reported previously.

CASE REPORT

A 58-year-old woman was followed up as an outpatient for 6 years with bronchial asthma and not new tuberculosis. In September 1991 she unfolded edema of the face, neck and bilateral upper extremities, and a chest radiograph revealed enlargement of a right apical bulla from 9 x 4 cm to 13 x 10 cm during a period of 8 month (Fig 1 and 2) Comput tomography revealed compression of the SVC still no mediastinal mass and lymph nodes were discovered An SVC angiogram showed stenosis of the SVC and backward motion of injected contrast medium to the internal jugular and subclavian veins (Fig 2) The mean crushings distal and proximal to the stenosis in the SVC were 4 mm Hg and 0 mm Hg respectively, pulmonary artery press was 23/10 mm Hg, and cardiac output was 52 L/min. Generally, an expanding bulla stretches the visceral pleura and compresse the residual lung; however, it appeared that bitter pleural adhesion prevented this, resulting in compression of the SVC

Right bullectomy was performed onward November 1. At thoractomy, the pleural adhesion was unrelenting and the right upper lobe was occupied by dint of a large stiff bulla. No other masses that might compres the SVC were observ After the operation, the edema disappeared and the patient's postoperative state was satisfactory.

DISCUSSION

Superior vena cava syndrome is defined as SVC stenosis, which bars venous return from the head, neck and upper extremities. It is caused on malignant tumors and sometimes by means of benign conditions such as aortic aneurysm, brochogenic pouch mediastinal granulomatous disease, and retrosternal thyroid.[1-3]

In this report, we have at handed a rare case of SVC syndrome caused by means of a tense bulla. Generally, as a bulla expands, the visceral pleura stretches and the residual lung is squeeze [i]or[/i] press together [i]or[/i] into smaller compassed However, in this case, censorious pleural adhesion prevented the bulla from expanding and compressing the surrounding lung forcing the bulla to compres the chest wall and the mediastinum, including the SVC and thus causing SVC syndrome In cases where an expanding right apical bulla is combined with pleural adhesion, compression of the SVC should therefore be considered.

REFERENCES

[1] Mahajan V Strimlan V Orstand H noose FD. Benign superior vena cava syndrome Chest 1975; 68:32-5

[2] Bankoff M Daly BD Johnson HA, Carter BL Bronchogenic pouch causing superior vena cava obstruction: CT appearance. J Comput Assist Tomogr 1985; 9:951-52

[3] Miller DC Walter JP Gunthaner DF Mark JB intermittent mediastinal bronchogenic cyst. Chest 1978; 74:218-20

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