HEMATOLOGY, ONCOLOGY, ALLERGY,AND IMMUNOLOGYCauda equina syndrome is a
form of spinal cord
compression involving the
terminal portion of the cord.
Patients present with some
combination of low back pain,
saddle anesthesia, bowel and
bladder dysfunction, and
lower extremity motor and
sensory loss.DIAGNOSIS
■ Plain films: Identify fracture
■ MRI spine: Gold standard
■ Myelography: If MRI is unavailable
TREATMENT
■ Pain control
■ Dexamethasone
■ Radiation therapy
■ Neurosurgery: Decompression laminectomy
Superior Vena Cava (SVC) Syndrome
SVC syndrome is obstruction of the SVC from underlying malignancy. Obstruc-
tion may be due to external pressure on the SVC or invasion of the SVC by
tumor and resultant thrombosis.
CAUSES
Common causes include bronchogenic carcinoma, small cell lung CA, squa-
mous cell lung CA, and lymphoma.
SIGNS/SYMPTOMS
■ Facial/upper extremity edema, shortness of breath, headache, chest pain
■ Facial plethora, distended neck/chest veins
DIAGNOSIS
■ CXR: Evaluate for widened mediastinum
■ CT chest with IV contrast
■ MRI: If neck pain is also present, to rule out spinal cord compression
TREATMENT
■ Supplemental O 2
■ Raise head and upper body
■ Steroids
■ Diuretics
■ Vascular stents, thrombolytics, and radiation may be used to improve SVC
flow depending on the type of tumor and its location.
An 18-year-old patient with Burkitt’s lymphoma presents 3 days after his last
chemotherapy with fatigue, muscle spasms, and palpitations. Labs obtained
show elevated potassium, uric acid, and phosphate levels, and decreased
calcium level. The patient’s monitor shows a widened QRS complex. What is your
suspected diagnosis and next step in management?
Tumor lysis syndrome and hyperkalemia. Administer calcium gluconate, insulin
IV, one ampule D50, one ampule bicarbonate, albuterol nebulizer, and kayexylate.Tumor Lysis Syndrome
Death of numerous neoplastic cells causes release of large quantities of intra-
cellularcontent and uric acid in the bloodstream. This typically follows 1–3 days
after the last chemotherapy of hematologic malignancies (most commonly
Burkitt’s lymphoma). Tumor lysis syndrome is also more likely to develop in
patients with underlying renal insufficiency.