Fatal superior vena cava syndrome after endoscopic variceal sclerotherapy.

A 50−year−old woman with primary bili− ary cirrhosis (Child±Pugh class C) was ad− mitted with esophageal variceal bleeding, and emergency endoscopic variceal scle− rotherapy (EVS) with 16 ml of 5 % ethanol− amine oleate was carried out. She had ex− perienced two episodes of variceal bleed− ing during the previous 6 months and had been treated with emergency EVS, fol− lowed by weekly elective sessions, receiv− ing a total of 90 ml of ethanolamine ole− ate. Four days after the last EVS session, the patient developed marked edema in the right arm. Chest computed tomog− raphy and cardiac ultrasonography were normal. Contrast venography revealed partial obstructions of the right brachio− cephalic and right subclavian veins (Fig− ure 1). She progressively developed neck and face edema, jugular congestion, and dilated veins in the head and anterior chest wall, indicating the development of superior vena cava syndrome. There was no evidence of infection, and a central ve− nous catheter had not been placed. The portal venous system was patent on Doppler ultrasonography. Acquired and inherited thrombophilic factors were ex− cluded. Steroids failed to bring about clin− ical improvement, and the patient died a few days later.