View source for Superior vena cava syndrome

==Background==
[[File:Gray505.png|thumb|SVC anatomy.]]
*External compression by extrinsic malignant mass causes majority of cases
*Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause
*Other causes include benign tumors, aortic aneurysm, infections, and fibrosing mediastinitis<ref> Nickloes TA, Lopez Rowe V, Kallab AM, Dunlap AB (28 March 2018). "Superior Vena Cava Syndrome". ''Medscape''</ref>
*Rarely constitutes an emergency
**Gradual process; collaterals dilate to compensate for the impaired flow
**Exception is neurologic abnormalities due to [[increased ICP]], laryngeal edema causing [[stridor]], [[shock|decreased cardiac output]]

===Risk Factors===
*Lung Cancer
*[[Lymphoma]]
*Indwelling vascular catheters (increasing incidence)
*Thrombophilia
*[[thyroid|Goiter]]
*[[TB]]
*Radiation
*Pericardial constriction

==Clinical Features==
[[File:PMC4962438 12886 2016 301 Fig1 HTML.png|thumb|SVC syndrome with classic symptoms, including obvious face, neck, and upper trunk swelling.]]
*[[Facial swelling]]
**Worse in morning, gets better as day progresses
*[[Headache]]
*[[Cyanosis]]
*[[Dyspnea]]
*[[Cough]]
*[[Arm swelling]]
*Distended neck/chest wall veins
*Telangiectasia
*Neurologic abnormalities (rare)
**[[visual disturbances|Visual changes]]
**[[Dizziness]]
**[[Confusion]]
**[[Seizure]]
**[[Syncope]]
**[[Papilledema]] and [[elevated ICP]]

==Differential Diagnosis==
{{Facial swelling DDX}}

{{Oncologic emergencies DDX}}

==Evaluation==
[[File:SVC_syndrome.jpg|thumb|CT chest showing right lung tumor compressing SVC]]
*CT with IV contrast
**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)
*[[CXR]]
**Shows mediastinal mass or parenchymal lung mass (10% of patients)

==Management==
*Elevate head of bed
*Assess for and treat [[elevated intracranial pressure]]
*Use IVs placed in lower extremities to avoid further SVC venous congestion<ref>Chaudhary K, Gupta A, Wadhawan S, Jain D, Bhadoria P. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2016 Jul 19];28:242-6. Available from: http://www.joacp.org/text.asp?2012/28/2/242/94910.</ref>
*Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team<ref>McCurdy M et al. Oncologic emergencies, part I: spinal cord compression, superior vena cava syndrome, and pericardial effusion. Emergency Medicine Practice. 2010; 12(2):7-10.</ref>
*Intravascular stent, consult IR
*If malignancy
**Mediastinal radiation, consult oncology/radiation oncology
*If thrombus
**[[Anticoagulation]], catheter removal, consider [[thrombolytics]]

==Disposition==
*Admit to ICU, with plan for airway monitoring and tissue biopsy

==References==
<references/>

[[Category:Heme/Onc]]