Emergency imaging in paediatric oncology: a pictorial review

AbstractDespite the decline in mortality rates over the last 20 years, cancer remains one of the leading causes of death in children worldwide. Early recognition and treatment for acute oncological emergencies are vital in preventing mortality and poor outcomes, such as irreversible end-organ damage and a compromised quality of life.Imaging plays a pivotal and adjunctive role to clinical examination, and a high level of interpretative acumen by the radiologist can make the difference between life and death. In contrast to adults, the most accessible cross-sectional imaging tool in children typically involves ultrasound. The excellent soft tissue differentiation allows for careful delineation of malignant masses and along with colour Doppler imaging, thromboses and large haematomas can be easily identified. Neurological imaging, particularly in older children is an exception. Here, computed tomography (CT) is required for acute intracranial pathologies, with magnetic resonance imaging (MRI) providing more definitive results later.This review is divided into a ‘body systems’ format covering a range of pathologies including neurological complications (brainstem herniation, hydrocephalus, spinal cord compression), thoracic complications (airway obstruction, superior vena cava syndrome, cardiac tamponade), intra-abdominal complications (bowel obstruction and perforation, hydronephrosis, abdominal compartment syndrome) and haematological-related emergencies (thrombosis, infection, massive haemorrhage). Within each subsection, we highlight pertinent clinical and imaging considerations.The overall objective of this pictorial review is to illustrate how primary childhood malignancies may present with life-threatening complications, and emphasise the need for imminent patient management.

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Developmental anomalies of the superior vena cava and its tributaries: What the radiologist needs to know?

British Journal of Radiology ◽

10.1259/bjr.20200856 ◽

2020 ◽

pp. 20200856

Author(s):

Mansi Verma ◽

Niraj Nirmal Pandey ◽

Vineeta Ojha ◽

Sanjeev Kumar ◽

Sivasubramaniam Ramakrishnan

Keyword(s):

Superior Vena Cava ◽

Imaging Techniques ◽

Superior Vena ◽

Vena Cava ◽

Clinical Importance ◽

Cross Sectional ◽

Developmental Anomalies ◽

Ct Venography ◽

Pictorial Review ◽

Cross Sectional Imaging

Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often asymptomatic, they assume clinical importance during interventions such as central venous catheterisations and pacemaker implantations and during cardiothoracic surgeries while instituting cardiopulmonary bypass and for creation of cavo-pulmonary connections. Role of imaging in identifying these anomalies is indispensable. Cross-sectional imaging techniques like CT venography and magnetic resonance (MR) venography allow direct visualisation and consequently increased detection of anomalies. CT venography plays an important role in detection of SVC anomalies as it is readily available, has excellent spatial resolution, short acquisition times and potential for reconstruction of images in multiple planes. This pictorial review focuses on the developmental anomalies of the SVC and its tributaries highlighting their embryological basis, imaging appearances on CT venography and potential clinical implications, where relevant.

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INTENSIVE CARE OF LIFE-THREATENING CONDITIONS IN PEDIATRIC ONCOHEMATOLOGY

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-5-138-144 ◽

2021 ◽

Vol 100 (5) ◽

pp. 138-144

Author(s):

N.V. Matinyan ◽

◽

T.T. Valiev ◽

K.I. Kirgizov ◽

S.R. Varfolomeeva ◽

...

Keyword(s):

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Adverse Outcomes ◽

Malignant Neoplasms ◽

Neutropenic Enterocolitis ◽

Compression Syndrome ◽

Life Threatening ◽

Spinal Cord Compression Syndrome

Malignant neoplasms of the blood system in children are represented by highly aggressive variants, which at the stage of diagnosis and program chemotherapy can be complicated by the development of life-threatening conditions. Understanding the risk of possible complications allows you to effectively carry out preventive and therapeutic measures, to minimize adverse outcomes. This article presents modern approaches to the diagnosis and treatment of the most common life-threatening conditions in pediatric oncohematology: acute tumor lysis syndrome, typhlitis and neutropenic enterocolitis, superior vena cava syndrome, malignant airway compression syndrome, acute impairment of consciousness, spinal cord compression syndrome, thrombosis, methemoglobinemia.

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Emergencies in Hematology and Oncology

10.2310/em.4020 ◽

2015 ◽

Author(s):

David P Curley

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Magnetic Resonance Image ◽

Superior Vena ◽

Risk Index ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Severe Infection ◽

Cord Compression ◽

Tumor Lysis

Clinicians must be able to recognize and treat emergencies associated with malignancies and cancer treatment. Such emergencies include metabolic, neurologic, cardiovascular, hematologic, and infectious emergencies. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment and disposition and outcomes for these emergencies in hematology and oncology. Figures show mechanisms of spinal cord compression, a magnetic resonance image showing a metastasis to the thoracic spine compressing the spinal cord, a contrast-enhanced magnetic resonance image of a 54-year-old female with metastatic ovarian cancer, an electrocardiogram and a cardiac echocardiogram of a 50-year-old female with malignant pericardial effusion with cardiac tamponade, a computed tomography scan of a mass compressing the superior vena cava, a blood smear from a patient with acute myeloid leukemia, and an algorithm showing the initial management of fever and neutropenia. Tables list the management of hypercalcemia of malignancy; Cairo-Bishop definition of laboratory and clinical tumor lysis; grading, risk stratification, and management of tumor lysis syndrome; management of intracranial hypertension and seizures in adults; factors favoring low risk of severe infection in patients with neutropenic fever; Multinational Association for Supportive Care in Cancer (MASCC) risk index score; and indications for the addition of a gram-positive antibiotic to the initial empirical regimen. This review contains 8 highly rendered figures, 9 tables, and 136 references.

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Emergencies in Hematology and Oncology

10.2310/im.1020 ◽

2012 ◽

Author(s):

Thorvardur R. Halfdanarson ◽

William J Hogan ◽

Timothy J Moynihan

Keyword(s):

Spinal Cord ◽

Pericardial Effusion ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Tumor Lysis ◽

Malignant Pericardial Effusion ◽

Vena Cava Syndrome

With the rising incidence of malignancies and expanding treatment options, clinicians must learn to recognize and treat emergencies associated with them. Oncologic emergencies can be broadly classified according to organ systems, which can facilitate recognition and management. Pathophysiology, presentation, diagnosis, and treatment are discussed for complications categorized by metabolic emergencies (hypercalcemia of malignancy, tumor lysis syndrome, lactic acidosis), neurologic emergencies (malignant spinal cord compression, brain metastases, and increased intracranial pressure), cardiovascular emergencies (malignant pericardial effusion and tamponade, superior vena cava syndrome), hematologic emergencies (hyperviscosity due to monoclonal proteins, hyperleukocytosis and leukostasis), infectious emergencies (neutropenic fever, neutropenic enterocolitis, fever associated with splenectomy or functional asplenia), and pulmonary emergencies (acute airway obstruction, acute airway hemorrhage). Figures illustrate spinal cord compression, brain metastases, electrical alternans, malignant pericardial effusion, superior vena cava syndrome, hyperleukocytosis, and an algorithm for initial management of fever and neutropenia. Tables cover management of hypercalcemia of malignancy; the Cairo-Bishop definition of laboratory and clinical tumor lysis; grading, risk stratification, and management of tumor lysis syndrome; management of intracranial hypertension and seizures; infection in patients with neutropenic fever; the Multinational Association for Supportive Care in Cancer Risk Index; and indications for the addition of a gram-positive antibiotic to the initial empirical regimen. This chapter contains 181 references.

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Oncological emergencies

Oxford Handbook of Cancer Nursing ◽

10.1093/med/9780198569244.003.0054 ◽

2007 ◽

pp. 655-674

Keyword(s):

Spinal Cord ◽

Allergic Reaction ◽

Disseminated Intravascular Coagulation ◽

Superior Vena ◽

Vena Cava ◽

Cord Compression ◽

Tumour Lysis ◽

System Involvement ◽

Intravascular Coagulation ◽

Systemic Allergic Reaction

Anaphylaxis 656 Disseminated intravascular coagulation 658 Malignancy induced hypercalcaemia 660 Spinal cord compression 664 Superior vena cava obstruction 668 Syndrome of inappropriate antidiuretic hormone 670 Tumour lysis syndrome 672 Anaphylaxis is a severe systemic allergic reaction with multi-system involvement. Onset is normally immediate, but there can be a delay of hours....

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Urgent Syndromes at the End of Life

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0026 ◽

2019 ◽

pp. 344-355

Author(s):

Quinten Robertson ◽

Kelli Gershon

Keyword(s):

End Of Life ◽

Superior Vena ◽

Life Stage ◽

Vena Cava ◽

Cord Compression ◽

Medical Intervention ◽

Her Family ◽

Disease Trajectory ◽

Appropriate Education

During the end-of-life stage, patients can experience a variety of urgent syndromes that can be treated effectively to reduce pain and improve quality of life. Conditions such as superior vena cava obstruction, pleural effusion, hemoptysis, spinal cord compression, hypercalcemia, and pathological fractures often result from progression across the disease trajectory and are particularly common among patients with advanced cancers. Nursing and medical caregivers must be familiar with these conditions, recognize them when they occur, and provide appropriate education and support for the patient and his or her family in addition to effective medical intervention. Awareness of urgent syndromes that may occur at end of life can help caregivers to provide more effectual palliative care that diminishes distress and suffering for the patient and their family.

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Oncologic Emergencies

AACN Advanced Critical Care ◽

10.4037/nci.0b013e318230112b ◽

2011 ◽

Vol 22 (4) ◽

pp. 337-348 ◽

Cited By ~ 1

Author(s):

Regan Demshar ◽

Rachel Vanek ◽

Polly Mazanec

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Hemodynamic Instability ◽

Cord Compression ◽

Current Evidence ◽

Oncologic Emergencies ◽

Life Threatening

The picture of oncologic emergencies in the intensive care unit has changed over the past decade. The classic emergencies, that is, superior vena cava syndrome, spinal cord compression, tumor lysis syndrome and life-threatening hypercalcemia, are now routinely managed on the general oncology unit or in an outpatient setting. Vigilant monitoring for early signs of complications, proactive interventions to prevent complications, and aggressive management account for this change. Currently, emergent conditions that necessitate intensive care unit admission or transfer in the patient with cancer include respiratory failure, cardiac emergencies, hemorrhagic events and coagulopathies, sepsis, and hemodynamic instability. This article will present the current evidence-based management of these conditions, a brief summary of classic oncologic emergencies, and the role of the critical care nurse in meeting the multidimensional needs of the patient and family during the life-threatening episode, based on Ferrell’s quality of life model.

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Oncologic Emergencies (DRAFT)

10.1093/med/9780190612474.003.0017 ◽

2018 ◽

Author(s):

Harry S. Rafkin

Keyword(s):

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Initial Assessment ◽

High Morbidity ◽

Patients With Cancer ◽

Oncologic Emergencies ◽

Life Threatening ◽

Vena Cava Syndrome

Oncologic emergencies are potentially life-threatening syndromes that occur in patients with cancer, and are either directly or indirectly related to the patient’s tumor. The clinical progression of these syndromes is rapid and the initial assessment of the patient must be done quickly, as without immediate therapy, high morbidity and mortality results. The oncologic emergency may be due to the tumor, the treatment given to control the tumor, or it may be due to a previously existing condition. This chapter reviews the clinical presentation, treatment, and management of tumor lysis syndrome, hypercalcemia, hyponatremia, disseminated intravascular coagulation, hyperviscosity syndrome, spinal cord compression, and superior vena cava syndrome.

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