Superior vena cava syndrome

Background

1. External compression by extrinsic malignant mass causes majority of cases
2. Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause
3. Infection
4. Rarely constitutes an emergency
   1. Gradual process; collaterals dilate to compensate for the impaired flow
   2. Exception is neurologic abnormalities due to increased ICP, laryngeal edema causing stridor, decreased cardiac output
5. Risk Factors:
   1. Lung Cancer
   2. Lymphoma
   3. Indwelling vascular catheters

Clinical Features

1. Facial swelling
2. Dyspnea
3. Cough
4. Arm swelling
5. Distended neck/chest wall veins
6. Neurologic abnormalities (rare)
   1. Visual changes
   2. Dizziness
   3. Confusion
   4. Seizure

Diagnosis

1. CT w/ IV contrast
   1. Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)
2. CXR
   1. Shows mediastinal mass or paranchymal lung mass (10% of pts)

Treatment

1. Elevate head of bed
2. Corticosteroids
   1. Effective if pt has steroid-responsive malignancy (e.g. lymphoma, thymoma)
3. Loop diuretic
   1. Questionable efficacy
4. Mediastinal radiation
5. Intravascular stent

Source

Tintinalli