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Face Inflammation. Angiography Shows Focal Stenosis, Dilated Azygos And Hemiazygos. What To Do?

Posted on Fri, 12 Apr 2013

Question: Hi
My father has been suffering from face inflation and pressure since the last 6 months. This problem is more prominent when he wakes up from sleep in morning or while taking bath. His CT Chest Angiography report says the following:

"Severe focal stenosis is seen in SVC at level of azygos vein. Pacemaker leads are seen in SVC. Dilated azygos and hemiazygos system seen"

PFA the scanned copy of the report.

Please advice what should he do now based upon this finding.

Answered by Dr. Anantharamakrishnan (39 minutes later)

Hi friend,
Welcome to Health Care Magic

There is obstruction at the level of SVC – Superior Vena Cava.
The cause of obstruction is not clear – most probably, thrombosis around the pacemaker lead.
Pulmonary embolism is a threat...
Venous angiography is usually necessary to delineate the details.

Only the doctor who has examined and is handling the case can take proper decision... Combined approach by Cardiologist and Vascular Surgeon is necessary for further assessment and assistance to plan further management – thrombolysis or surgery

He is in good hands / The hospital is an excellent one with the state of the art facilities / Rest assured they will be doing the best...

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (18 hours later)

Thank you for the reply
And please inform me is there any chances of any risk ? and if surgery is needed then can it be postpone for 2/3 months ? we have some problems during this period ?

Thanks
XXXXXXX

Answered by Dr. Anantharamakrishnan (19 minutes later)

It is a very tricky situation and the choice is difficult -

Surgery carries a definite risk.

Without surgery also, there is a definite risk - of Pulmonary embolism.
The risk may be reduced by anticoagulant like Warfarin; but Warfarin has its own pros and cons.

On the whole, surgery is better / earlier the better.
Discuss with the treating doctor.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (43 minutes later)

thank you once again for the reply ..

i'll surely tell to my father about your suggestion, actually i'm here at Bangalore and my father is in KOlkata. i'm too much worried about this condition.

So i'm disturbing you once again if you kindly inform this also WHAT TYPE OF RISK can it be for surgery ? and also i have checked from google that taking this type of medicine - Warfarin has even life risk also, is it true?

And if surgery is not possible withing 3months WHAT TYPE OF RISK can happen ?

Answered by Dr. Anantharamakrishnan (25 minutes later)

It is difficult to tell except after examining the patient and reviewing the entire record of investigations.

Generally, if the dose of Warfarin is more (high INR), bleeding can occur - anywhere. If the dose is less (low INR), it has no effect. The therapeutic window is narrow and it need constant monitoring.

Without surgery, the commonest risk is sudden death from Pulmonary Embolism.
Increasing venous obstruction, lowering of cardiac output, infection and so on an also occur...

Bleeding, embolism, tear, infection, cardiac arrest etc can occur during surgery

Only the examining doctor can guide better

Regards
God bless

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar