Superior vena cava syndrome

Pathophysiology

1. Occurs in 3-8% with lung cancer and lymphoma
2. Symptoms due to venous hypertension in areas drained by SVC
3. Deaths occurs from cerebral edema, airway compromise, or cardiac compromise

Clinical features

1. Thoracic or neck vein distention - 65%
2. Shortness of breath - 50%
3. Tachypnea - 40%
4. Upper trunk or extremity edema - 40%
5. Cough/dysphagia/chest pain - 20%
6. Peri-orbital or facial edema - ?
7. Stroke's sign (tight shirt collar) - ?

Diagnosis

1. CXR shows mediastinal mass or paranchymal lung mass in 10%
2. CT is diagnostic

Management

1. Furosemide 40mg IV
2. Methylprednisolone 1-2 mg/kg IV
3. Mediastinal radiation

Source

Sotelo 10/09