Superior vena cava syndrome. Symptoms, causes, manifestations of superior vena cava syndrome and treatment of cava syndrome This operation has many negative qualities

At the moment, no clear treatment regimen for inferior vena cava syndrome has been developed. In most situations, conservative therapy is used with the mandatory prescription of drugs that affect blood clotting, both direct and indirect.

When prescribing medication, one should take into account the duration of the disease, which this syndrome it is practically impossible to determine. It is known that antithrombotic agents have the greatest effect only at the initial stages of blockage formation.

Maintaining normal functioning of the kidneys and liver is also important.

The main vitamins that help strengthen the venous walls are tocopherol and ascorbic acid. Foods rich in these vitamins reduce the likelihood of blood clots and blockage of the inferior vena cava.

Tocopherol (b. E) is present in beans, cereals, liver, broccoli, and also in vegetable oils.

Ascorbic acid is found in sufficient quantities in berries, grapes, kiwi and citrus fruits.

In addition, it is advisable to eat foods rich in carotene, rutin, as well as microelements such as copper, iron and zinc. To do this, you need to cook dishes from cabbage, nuts, red fruits and vegetables, and meat more often.

Physiotherapeutic treatment for inferior vena cava syndrome is used extremely rarely. Appointment possible physical therapy, manual therapy(according to testimony).

Homeopathy has been treating diseases such as inferior vena cava syndrome for many years. In this case, homeopathic doctors advise using products that strengthen vascular walls, regulate blood circulation and improve blood properties. Treatment tactics are usually determined depending on the disease or condition that may have caused the blockage of the vein.

IN Lately The following homeopathic remedies are of interest:

• Crotalus (striped rattlesnake) – Heel brand products are used, such as Crotalus-Heel and Crotalus-Heel forte, in dilutions of 12, 30, 200;
• Aesculus (horse chestnut extract) – prescribed in the form of injections (preparations Aesculus Ingeel and Aesculus Ingeel Forte), or in the form of solutions of Aesculus Heel, Arnica Heel or Arteria Heel, 10-15 drops three times a day;
• Vipera berus (a drug from viper venom) - used in the form of injections of the drug Vipera berus Ingeel. Dosage D–15, 30, 200.

In addition, drugs prepared on the basis of coagulation factors can be prescribed: thrombin, fibrinogen, fibrin, etc. In the future, it is recommended to use Aorta suis Ingeel, Arteria suis Injeel, Vena suis Ingeel, which are made from thrombotic material.

Surgical treatment is prescribed for thrombosis of the inferior vena cava:

• in the presence of thromboembolism of the lumen of the inferior vena cava;
• when the venous vessels of the liver or kidneys are blocked with impaired organ function;
• with coarctation of the inferior vena cava;
• with “long-standing thrombosis” (more than 14-20 days).

The operation is performed under intubation anesthesia using muscle relaxant drugs. The surgeon performs a median laparotomy, thoracophrenolumbotomy, or different kinds extraperitoneal access. The trunk of the inferior vena cava is isolated, clamps are applied and a radical removal of a blood clot or other cause that interferes with normal blood circulation in the vessel is performed. If a narrowed area is detected, balloon dilation is performed with further stenting.

Traditional treatment

In consultation with your doctor, you can use the following traditional recipes:

• Take 15 g of verbena leaf and brew it in a glass of boiling water. Take 1 tbsp. l. every hour until the condition improves.
• Drink a third of a glass of infusion from St. John's wort, plantain, dried herb, coriander, licorice rhizome and string. To prepare the infusion, you will need 2 tbsp. l. an equivalent mixture of the listed plants and 220 ml of boiling water. The medicine is taken half an hour before meals.
• Take ground nutmeg with regular water. warm water or tea.
• Take 0.3 g of mumiyo orally twice a day, or in combination with honey and milk. Duration of treatment – ​​up to 25 days in a row.

Herbal treatment often includes complex multi-component recipes.

During pregnancy, a woman's body experiences significant stress. The volume of circulating blood increases, conditions for venous stagnation appear.

The growing uterus squeezes blood vessels and surrounding organs, causing disruption of blood supply. One result of these changes is inferior vena cava syndrome. Its hidden manifestations are present in more than half of women, and clinically it manifests itself in every tenth pregnant woman. Severe cases of this disease occur in one in a hundred pregnant women.

Synonyms for this condition:

• hypotensive syndrome on the back;
• aortocaval compression syndrome;
• postural hypotensive syndrome;
• hypotensive syndrome of pregnant women in the supine position.

Why does this condition occur?

The inferior vena cava is a large diameter vessel through which from the legs and internal organs venous blood is drained. It is located along the spine. Its walls are soft, the pressure in the venous system is low, so the vein is easily compressed by the enlarged uterus.

Signs of such compression begin to occur periodically in the third trimester of pregnancy if the woman is in a supine position.

When this large vein is compressed, the outflow of blood through it to the heart is hampered, that is, venous return is reduced. As a result, the volume of blood passing through the lungs through the pulmonary circulation decreases. Blood oxygen saturation decreases, hypoxemia occurs.

Cardiac output decreases - the amount of blood ejected by the heart into the aorta. As a result of a small amount of blood and a reduced oxygen content in it, a lack of this gas occurs in all tissues - hypoxia. All organs of the woman and fetus suffer.

Suddenly falls quickly arterial pressure, in some cases up to 50/0 mmHg. Art.

On the other hand, a compressed inferior vena cava cannot pass the entire volume of venous blood from the legs and lower torso to the right atrium. Therefore, venous congestion develops in the veins of the lower extremities.

In the development of inferior vena cava syndrome, an increase in intra-abdominal pressure due to the growing uterus, elevation of the diaphragm and compression of all great vessels abdominal cavity and retroperitoneal space. Many pregnant women develop a network of collaterals - bypasses venous outflow, as a result of which the syndrome in question does not occur in them.

How does the condition manifest?

The inferior vena cava is compressed by the enlarged uterus when the woman is lying on her back. At long gestation periods or with polyhydramnios, this can also occur in an upright position of the body.

The first symptoms appear at about 25 weeks. It becomes difficult for a woman to lie on her back, and she may experience dizziness, shortness of breath, and weakness. Blood pressure decreases. In some cases, even collapse with fainting occurs.

In severe cases, a woman quickly turns pale 2 to 3 minutes after turning on her back, complains of dizziness and darkening of the eyes, nausea and cold sweat. More rare signs are ringing in the ears, heaviness behind the sternum, a feeling of strong fetal movement.

Sudden onset of pallor and hypotonia closely resembles internal bleeding, so the doctor may mistakenly suspect placental abruption, uterine rupture, etc. in such a pregnant woman.

The appearance of a vascular pattern is also associated with the described syndrome. One of the common manifestations of this condition is.

Described pathological condition leads to fetal hypoxia and disturbance of its heartbeat. The development of organs and systems of the unborn child suffers. If it occurs during childbirth, it can cause fetal asphyxia. The connection of this disease with premature detachment of a normally located placenta has been proven.

What to do in this condition

What not to do in the third trimester of pregnancy:

• A pregnant woman over 25 weeks should not sleep on her back;
• prohibited from practicing physical exercise performed lying on your back, including with tension in the abdominal muscles.

• It is recommended to rest lying on your left side or in a semi-sitting position;
• It is useful to use special pillows for pregnant women, which are placed under the back or between the legs when lying on your side. Changing body position helps prevent compression of abdominal vessels by the uterus;
• To normalize venous outflow and improve hemodynamics, rational physical activity, especially walking, is recommended. While walking, the muscles of the legs actively contract, which helps move venous blood upward;
• Exercises in water are useful. Water has a compression effect, squeezing blood out of the veins of the lower extremities;
• During childbirth, the preferred position is lying on the left side or with the head end of the bed raised high.

Superior vena cava syndrome is a disorder that involves a disturbance in the flow of venous blood from the upper body (circulatory disorder). The basis of this disease is compression of the vein or the occurrence of a blood clot, which actually disrupts its outflow from the head, shoulders and upper half of the body. This can lead to serious complications that can threaten a person’s life. This disorder is often diagnosed between the ages of thirty and sixty (several times more often in males than in females).

Main clinical manifestations diseases are - the appearance of a bluish tint on the skin, the formation of shortness of breath, a change in the timbre of the voice, swelling of the face and neck, difficulty breathing, pain in the area chest, as well as fainting or convulsive state. Secondary symptoms include decreased hearing and visual acuity.

Diagnostic measures include radiography, ultrasound, MRI, CT and other instrumental examinations of the chest. Treatment of the disease is aimed at eliminating the pathology through surgical operations.

Etiology

There are many reasons for the formation of this pathology, the main of which are:

• external compression of the vein;
• blood clot formation;
• education malignant tumor right lung is the main factor in the occurrence of such pathology.

Other predisposing factors may be:

• organ tumors digestive system of different nature, which are located in the diaphragm area;

In addition, a similar disorder can be observed during the course of certain diseases. Among which:

• goiter of the retrosternal region;
• cardiovascular failure;
• pathological effects of pathogens;
• a wide variety ;
• proliferation of fibrous tissue.

There is a possibility of the disease occurring as a response of the body to surgery, as well as from prolonged use of a venous catheter.

Symptoms

Emergence characteristic features is caused by an increase in pressure in the vessels, and the degree of their manifestation is influenced by the rate of progression pathological process and the degree of circulatory impairment. The main symptoms of the disease include:

• attacks of severe headache;
• the occurrence of shortness of breath not only with physical activity, but also at rest;
• difficulty breathing;
• soreness in the chest area;
• cyanosis of the skin of the upper body;
• change in voice timbre. Often it becomes hoarse, the person constantly wants to clear his throat;
• swelling of the face and neck;
• constant drowsiness and lethargy;
• the appearance of seizures;
• fainting.

Secondary signs of this syndrome are patient complaints of decreased hearing and visual acuity, the occurrence of tinnitus, as well as auditory hallucinations and increased tearfulness. The intensity of symptoms is individual for each person, which is determined by the speed of spread of the pathogenic process. The greater the compression of the vein, the smaller its lumen, which further impairs blood circulation.

Diagnostics

Diagnostic measures to establish a diagnosis of “superior vena cava syndrome” are based on an instrumental examination of the patient. But before this, the doctor needs to familiarize himself with the medical history, find out possible reasons formation of the disease, as well as the presence and intensity of symptoms.

Instrumental diagnostic methods include:

• X-ray of the chest area. Pictures are taken in several projections;
• tomography – in particular computed tomography, spiral and MRI;
• venography - carried out to identify the location of the pathogenic process;
• Doppler ultrasound of veins - such as carotid and supraclavicular;
• bronchoscopy - will help determine the causes of the disease, with the obligatory implementation of a biopsy;
• laboratory research sputum.

If necessary, diagnostic thoracoscopy, mediastinoscopy and consultation with an ophthalmologist are prescribed, during which intraocular pressure is measured. In addition, it is necessary to differentiate this pathology from congestive heart failure. After receiving all the examination results, the doctor prescribes the most effective treatment tactics for each patient.

Treatment

Are common therapeutic measures for all patients consist of constant oxygen inhalation, sedatives medicines, diuretics and glucocorticoids, adherence to a low-salt diet and bed rest.

Further treatment for each patient is individual and depends on the causes of such a syndrome:

• if the disease was caused by oncology of the right lung, metastases or other malignant neoplasms, then patients are prescribed chemotherapy or radiation treatment;
• in cases of disease formation due to thrombosis, thrombectomy is performed, often with removal of the affected part of the vena cava followed by the installation of a homograft.

If it is impossible to carry out radical surgical operations, other treatment methods are prescribed aimed at restoring the outflow of venous blood:

• deletion benign neoplasm mediastinal areas;
• bypass surgery;
• percutaneous balloon angioplasty;
• stenting of the superior vena cava.

In most situations, treatment of the disease is gradual and step-by-step, but sometimes emergency surgery may be required. This is necessary when:

• acute, which can lead to cardiac arrest;
• obvious difficulty in performing respiratory functions;
• brain lesions.

There is no specific prevention for this disease. The prognosis of the disease depends on the causes of such a disorder and timely initiation of therapy. Elimination of progression factors allows you to completely get rid of the syndrome. The acute course of the disease can cause rapid death of a person. If the disease was caused by an advanced form of cancer, the prognosis is extremely unfavorable.

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Diseases with similar symptoms:

As is known, the respiratory function of the body is one of the main functions of the normal functioning of the body. A syndrome in which the balance of blood components is disturbed, or, to be more precise, the concentration of carbon dioxide greatly increases and the volume of oxygen decreases, is called “acute respiratory failure”, it can also develop into chronic form. How does the patient feel in this case, what symptoms may bother him, what are the signs and causes of this syndrome - read below. Also from our article you will learn about diagnostic methods and the most modern methods of treating this disease.

Angiosarcoma is a malignant tumor. Vascular cancer is quite rare compared to other oncological diseases - approximately 3% of all diseases of this type. The disease is characterized by rapid development, rapid transition of metastases and their development. Vascular cancer is difficult to treat, the prognosis is disappointing, especially if the disease is not cured. initial stage.

What it is

Vascular cancer is angiosarcoma, malignant neoplasms that very quickly begin to metastasize. They are located on the inner side of the vascular wall. Develops with equal frequency in men and women. Cancerous tumors most often occur on the skin, liver, breasts, brain and spleen.

The causes of the occurrence are not fully understood; it is this factor that largely explains the impossibility of treatment traditional types therapy. The causes of development are considered to be exposure to arsenic, thorium dioxide, ionizing radiation. Chronic lymphedema and mutational processes are also called as the cause of the tumor.

The main distinguishing feature of vascular cancer is that the disease develops rapidly. Metastasis occurs instantly, in most cases, when the patient begins to notice symptoms, the disease is on advanced stage, therefore, cannot be treated.

Vein tumors are vascular cancer characterized by obstruction of blood flow in the vessels of the veins. This is caused, in addition to the main factors, by blood clots located in the vessels, as well as varicose veins.

Vein cancer is diagnosed independently only if the formation is located on the subcutaneous layer of the epithelium. In this case, you may notice a purple spot on the skin. But in most cases, vessels that are not on the surface are affected.

The impossibility of self-diagnosis and the late onset of symptoms (only when nerve fibers are compressed) make vein cancer a serious oncological disease that is practically untreatable.

Arterial cancer is a tumor on carotid artery. It does not develop so quickly, it is often benign, but it also often and suddenly begins to metastasize. It appears only in an advanced state, then the symptoms are expressed in the sensation of a pulsating mass on the neck.

Classification

The malignant formation has a dense texture with an uneven contour; inside it is filled with voids with blood. The formations are permeated with small vessels and capillaries, and can affect any part of the human body.

The disease is classified not only by how quickly it spreads in the body, but also by its location and the areas of the body that are primarily affected.

Highlight:

• vascular cancer general;
• vascular cancer heads;
• breast cancer;
• cancer caused by radial irradiation;
• hemangioendothelioma.

Common vascular cancer is small nodules, bluish-violet in color, that can spread to any area of ​​the skin. It is usually found on the legs, thighs, chest, and arms.

Over time, small nodules merge into a node. The usual cause of this type of cancer is disruption of the proper functioning of the lymphatic flow.

Cancer of the blood vessels of the head, idiopathic angiosarcoma, is characterized by the appearance of small compactions and nodules, which also eventually merge into a nodule. This cancer begins to metastasize very quickly, and the prognosis is negative in most cases.

It can affect both the area where there is hair, as well as the larynx, neck, pharynx, and tonsils. Mostly men (twice as often as women) over the age of 65 suffer from vascular cancer of the head.

Breast cancer appears in the form of small nodules, which can be pink, red, burgundy or blue in color. At the same time, the nodes are painful.

Over the course of several months, they transform into a tumor, which is surgically removed. Breast cancer, which is essentially vascular cancer, affects women between 35 and 45 years of age.

Cancer caused by radiation is called radiation cancer. Angiosarcoma rapidly spreads throughout the body and metastasizes instantly.

In terms of their manifestations, they are like ordinary vascular cancer, that is, the seals are small and do not cause discomfort. Localized on the chest, hips and abdomen.

Hemangioendothelioma is a tumor consisting of endothelial cells. The origin of the disease is practically unknown, and it is extremely difficult to treat.

Causes

The reasons for the appearance of malignant formations on the walls of blood vessels are not fully understood. However, the most common are:

• radiation, including those that were used as therapy in the treatment of other oncological diseases;
• mechanical injuries;
• mutation benign tumor.

It should be noted that angiosarcoma may appear as a result of training after several years. It can also form if a person regularly interacts with substances that can release polyvinyl chloride and arsenic.

Among other factors, vascular cancer can be caused by impaired immune function, vascular diseases, including varicose veins, hemochromatosis.

Symptoms

The appearance of vascular cancer initially appears as small lumps, usually purple or bluish in color. However, they can be of a different color, especially if they are located on the mammary glands - red, pink or blue. After a certain period (each patient has a different term), these small compactions merge and form a single round-shaped ball of pronounced purple color.

Other signs of vascular cancer development:

• dysfunction liver;
• general weakness body;
• manifestation swelling;
• anemia;
• sharp jumps temperature;
• unconditional decline weight;
• nausea and vomiting;
• manifestation ulcerative diseases.

The symptoms on the list are not associated only with vascular cancer. It also occurs with the development of other diseases that are not necessarily related to cancer. Only a specialist after examination can make an accurate diagnosis and prescribe a treatment plan.

Diagnostics

Determination and diagnosis occurs in several stages. After the medical history, an examination is scheduled, during which the oncologist determines the size of the tumor and its consistency. Palpation required.

If there are suspicions of cancer, then further diagnostic measures are carried out as follows:

• x-ray examination (degree of spread of metastases);
• MRI and CT scan (allows you to find out about the condition of tissues);
• biopsy(taking a small piece of tumor for analysis);
• Ultrasound;
• angiography(radiography is performed in this way);
• taking tests blood;
• detection of cancer markers.

The main method for this is biopsy. It is through clinical examination of a tissue sample that the diagnosis is confirmed or refuted. Other methods help determine the state of the blood and the spread of metastases.

Treatment

The initial stage, that is, the location of the tumor on the surface, in most cases is successfully treated. In this case, the tumor, if no metastases have appeared, is drained and sutures are applied. If the tumor is not located on the surface, then surgical removal of the entire limb is possible.

Surgery is performed modern techniques. Using computer technology, the optimal angle of amputation and the force of impact are calculated.

After surgery, the patient is prescribed radiation and chemotherapy. They help reduce the risk of relapse after surgery.

Detection of a neoplasm at the initial stage has a positive prognosis. At the same time, the picture worsens if the tumor has invaded the lymph node, metastases have appeared, location on mammary glands and head.

After the tumor is removed, the patient is registered with an oncologist. In the first two years, visits to the doctor are scheduled once a quarter, after this period - once every six months.

During the examination, a specialist conducts an examination skin lymph nodes, veins for the presence of an incipient disease (detects whether there are nodules, tumors). If necessary, lymph nodes are palpated. The patient also undergoes x-rays and tests. A biopsy is not required at this stage.

A detailed examination after surgery is necessary in order to promptly detect the spread of metastases and relapse of vascular cancer and prevent it.

Complications

Complications relate primarily to relapse and spread of metastases. A cancerous tumor, even if a limb is completely removed, may appear again. There is also a risk that the remaining metastases will begin to spread even faster.

Forecast

The prognosis for patients with vascular cancer is disappointing. Even a timely operation does not provide guarantees. Interventions are successful in 70% of cases, but as a result of relapse from vascular cancer, patients die within two years. Less than 10% of those who undergo surgery manage to live five years or more after it.

Prevention

There are no measures to prevent the development of the disease. But since cancer is caused by contact with chemicals, radiation exposure, it can be understood that the prevention of pathology will be their exclusion.

Vascular cancer is difficult to treat, and the prognosis is disappointing. Even with a successful operation, the disease requires careful attention. At the slightest suspicion of relapse, you should immediately contact an oncologist.

Superior vena cava syndrome consists of a group of symptoms that develop due to disruption of blood flow in the superior vena cava caused by external compression or thrombosis of the vessel itself. SVPV is a manifestation of other diseases, in particular lung cancer. Therefore, when signs of superior vena cava syndrome occur, it is necessary to immediately consult a doctor and have comprehensive examination. What is the cause of cava syndrome, symptoms and methods of treatment - in detail in the article.

Features of anatomy and provoking factors

The superior vena cava is located in the mediastinum. It is adjacent to the bronchi, chest wall, trachea, lymph nodes, and aorta. Damage to these organs or an increase in their size can cause compression of the said vessel and disruption of the outflow of blood from the upper part of the body, i.e., from the head, heart, lungs, and upper chest. Thus, when cava syndrome occurs, life-threatening conditions may occur. Manifestations of this disease most often occur in men between 30 and 60 years of age. Such patients are usually encountered by cardiologists, pulmonologists, phlebologists, and oncologists. The mechanisms of occurrence of cava syndrome are tumor invasion into the vessel wall, external compression, and thrombosis.

Most common cause Superior vena cava syndrome is caused by lung cancer. However, tumor invasion into the wall of the superior vena cava can also be provoked by the following neoplasms:

• Sarcoma.
• Lymphoma.
• Melanoma.
• Tumors of the digestive organs located near the vein.
• Mammary cancer.

Non-tumor causes of cava syndrome are as follows: retrosternal goiter, cardiovascular failure, infectious diseases, purulent mediastinitis, post-radiation fibrosis, constrictive pericarditis, idiopathic mediastinal fibrosis, sarcoidosis, mediastinal teratoma, long-term catheter placement in the superior vena cava, aortic aneurysm. Compression of the terminal section of the superior vena cava can cause expansion of the inferior vena cava, the causes of obstruction of blood flow in which are also quite varied and no less dangerous to health.

Most often, the syndrome occurs due to lung cancer.

Main manifestations

The syndrome of impaired blood flow in the superior vena cava is characterized by three main syndromes: cyanosis, swelling, and an increase in the diameter of the superficial veins of the upper half of the body. Patients are concerned about shortness of breath at rest, difficulty swallowing, hoarseness, cough, swelling of the face and neck. All these symptoms are significantly worse at rest, so a person suffering from this disease tends to take a semi-recumbent position.

Symptoms of suffocation that develop due to swelling of the larynx occur somewhat less frequently. This may lead to respiratory failure. Due to impaired outflow of venous blood, cerebral edema may develop. In this case, symptoms such as headaches, convulsions, confusion, tinnitus, drowsiness, and loss of consciousness occur.

Symptoms of dysfunction of the oculomotor and auditory nerves, expressed in lacrimation, double vision, exophthalmos, auditory hallucinations, hearing loss, and tinnitus, develop somewhat less frequently.

Increased pressure in the venous system leads to nasal, esophageal and pulmonary bleeding. In addition, swelling of the collar area occurs and upper limbs, bluish skin. These symptoms are clearly visible in the photo.

Methods for identifying the disease

In addition to standard examination methods, including interviewing the patient, visual examination and laboratory tests, diagnostic methods such as:

• Radiography in two projections.
• Computer and magnetic tomography.

TO additional methods studies aimed at detecting the cause of the syndrome include: examination of the fundus, measurement of intraocular pressure, bronchoscopy, sputum analysis, ultrasound examination of the carotid and supraclavicular veins, sternal puncture. In case of emergency, diagnostic thoracoscopy and parasternal thoracotomy can be performed.

To identify the disease, you can use the phlebography method.

Therapy methods

Treatment for superior vena cava syndrome includes complex therapy, aimed at eliminating the cause of this condition and alleviating the patient’s condition. This can be achieved using conservative and surgical methods.

Conservative treatment includes:

• Oxygen inhalations used for obstruction respiratory tract, as well as tracheostomy and tracheal intubation.
• For cerebral edema, diuretics and glucocorticosteroids are prescribed. If necessary, anticonvulsants are added to treatment.
• In the presence of malignant neoplasm you need to start treatment with radiation therapy. When combining intercellular lung cancer with lymphoma, chemotherapy is added to radiation therapy.
• Percutaneous placement of a stent allows you to cope with the lack of air.

If the cause of disruption of blood flow in the superior vena cava is a thrombus, then treatment is carried out with fibrinolytic drugs. If there is no effect from conservative treatment or if there is a significant deterioration in the patient’s health, surgical intervention is performed.

If the superior vena cava is compressed from the outside, then radical removal of the tumor is performed. If so surgical treatment is impossible, then surgical intervention is performed for palliative purposes. Among the methods aimed at improving the patient's condition, the following are distinguished: bypass surgery, stenting, percutaneous endovascular balloon angioplasty, removal of part of the tumor for the purpose of decompression.

Thus, the syndrome resulting from impaired blood flow in the superior vena cava can manifest itself with several ambiguous signs at once. Therefore, it is important to know its main symptoms. Depending on the severity of the condition and the cause of its occurrence, the method of treatment is selected; accordingly, the earlier the disease causing this syndrome is detected, the more complications can be avoided.