HRCR September 2020 Quiz

Editorial note: The following quiz is related to the article Benign vena cava superior syndrome in patients with cardiac implantable electronic devices: presentation and management by Eberhardt and colleagues from the September 2020 issue of Heart Rhythm Case Reports.

Question 1: Which of the following statements is correct with regard to signs and symptoms in benign vena cava superior syndrome?

a. Pleural effusions are always transudative.
b. Recurrence of pleural effusion after pleurocentesis is uncommon.
c. Postural syncope following orthostatic challenge might be a presenting symptom.
d. Presence of chylothorax excludes a benign etiology in vena cava superior syndrome.
e. Lower limb edema is a typical sign.

Question 2: This thoracic CT image (figure) in the sagittal plane has been obtained after application of contrast medium in the right cubital vein in a patient with superior vena cava syndrome. Which of the following statements is correct in relation to the anatomic structure marked by arrows?

a. This CT image shows the inferior vena cava.
b. Blood flow in the vena azygos is caudal to cranial in vena cava superior syndrome.
c. This CT image shows a dilated Vena azygos.
d. Physiologically, the vena azygos drains into the inferior vena cava.

Question 3: Which of the following statements regarding the management of benign vena cava superior syndrome in CIED patients is correct?

a. Pacemaker leads should be extracted by all means prior to endovascular therapy.
b. Balloon angioplasty without stenting is sufficient in the vast majority of cases.
c. Thrombolysis should be attempted in all cases of benign vena cava superior syndrome prior to endovascular therapy.
d. Surgical reconstruction of the SVC is an alternative to endovascular therapy, particularly in patients with fibrosing mediastinitis and recurrent occlusion.