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. Intravascular stent
5. If malignancy
   1. Mediastinal radiation
6. If thrombus
7. Anticoagulation, catheter removal, consider thrombolytics

Source

Tintinalli, Emedicine, Rosen's