Superior Vena Cava Syndrome Which Causes Gross Mass During Pregnancy Multidisciplinary Approach Ali Akdemir1, Çağdaş Şahin1, Seda Akgün1, Önder Kavurmacı2,

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Presentation transcript:

Superior Vena Cava Syndrome Which Causes Gross Mass During Pregnancy Multidisciplinary Approach Ali Akdemir1, Çağdaş Şahin1, Seda Akgün1, Önder Kavurmacı2, Ayşe Gül Ergönül2, Ufuk Çağırıcı2, Münevver Erdinç3 1Ege University Faculty Of Medicine, Obstetrics and Gynecology Department, İzmir 2Ege University Faculty Of Medicine, Thoracic Surgery Department, İzmir 3Ege University Faculty Of Medicine, Chest Diseases Department, İzmir

Superior Vena Cava Middle mediastinum right and left innominate veins right atrium 6-8 cm

Causes of SVCS Malignancy (80-90 %) Beingn (10-20 %) Bronchogenic carcinoma Metastatic pulmonary malignancy Metastatic mediastinal malignancy Lymphoma Leukaemia Beingn (10-20 %)

Presenting Signs And Symptoms Facial edema 82% Distanted neckveins Facial plethora Dyspnea Cough Hoarseness

Cases 32 years 26-27 weeks of pregnancy Additional diseases Ø 3 months ago progressive dyspnea and neck swelling

Imaging Thyroid ultrasound Echocardiography Magnetic resonance imaging 11X10 cm size mass SVCS Obstetric ultrasound

MRI

MRI

Diagnostic Procedures transthoracic biopsy open biopsy under local anesthesia CD20 + diffuse large B-cell lymphoma

Treatment CHEMOTHERAPY pregnancy medicines timing ethic termination emergency information

Surveillance Pulse steroid Betamethasone Arterial blood gas Biochemical parameters NST, ultrasound

Immediate Chemotherapy Rituximab Etoposide phosphate Prednisone Vincristine sulfate (Oncovin) Cyclophosphamide Doxorubicin Hydrochloride

Perinatology Committee Termination of pregnancy before 2. cure chemotherapy (35+0) 34+6 Water breaking Cervical dilatation

C/S , 2220 gr , baby boy , vertex the baby did not require neonatal intensive care lactation inhibition

2. cure R-EPOCH MRI Proliferation index 99% 3.-4. cure R-DHAP (Rituximab–Dexamethasone–Cytarabine– Cisplatin)

Discussion Physiological ? Pathology? Imaging Diagnosis Surveillance Treatment Side effects