(206) Case Report: Chronic Retropharyngeal Effusion caused by Superior Vena Cava Syndrome Following Intravascular Catheter Placement

Introduction: There are few documented cases of symptomatic retropharyngeal effusion occurring as a sequela of SVC syndrome. Because the overwhelming majority of clinically identified retropharyngeal fluid collections are of infectious or malignant origin, accurate recognition of this distinct subset is imperative, as diagnostic considerations and management strategies differ substantially.

Methods: This case report describes a 57-year-old female with polycystic kidney disease and end stage renal disease (ESRD) who required multiple transfers to University of Vermont Medical Center for right arm, face, and neck edema, difficulty breathing, and dysphagia. Upon initial presentation, she was status post hemodialysis tunneled catheter placement in her right internal jugular vein (IJV). Computed tomography (CT) scan showed a large, low-density retropharyngeal fluid collection measuring 6.0 x 3.5 x 1.5 cm in size, possibly of infected origin, and non-filling of the inferior aspect of the right and left IJVs.

Results: Airway-dosed steroids and anticoagulation were initially effective, but the patient subsequently developed recurrent symptoms and reaccumulation of her retropharyngeal fluid collection. She underwent central venography (CV) with interventional radiology which demonstrated superior vena cava occlusion. Removal of the right central venous catheter and superior vena cava recanalization led to complete resolution of symptoms.

Conclusions: The most emergent presentation of retropharyngeal effusion secondary to SVC syndrome is airway obstruction due to pharyngeal and laryngeal edema in the setting of rapid venous congestion. CT neck and chest imaging will demonstrate a homogenous, low-density fluid collection that often extends longitudinally across multiple cervical levels and additionally may show dilated collateral veins. Surgical interventions must be avoided, and instead, anticoagulation should be trialed with possible removal of offending catheter and SVC stenting if patients fail to improve.