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Diagnosing Superior Vena Cava Syndrome

Superior vena cava syndrome occurs when the SVC is extrinsically compressed or occluded. Thoracic malignant disorders are the most common cause, but SVCS also can be caused by SVC thrombosis and stenosis secondary to indwelling venous lines or pacemaker leads.

Highly proliferative tumors and SVC thrombosis can result in rapid onset of symptoms. The most common physical findings are facial, neck, and arm swelling and dilated veins in the chest.

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Articles of Interest

Episode 33: Oncologic Emergencies

Pemberton’s sign for SVC syndrome is facial redness caused by elevating the arms.

Malignant Superior Vena Cava Syndrome: State of the Art

Superior vena cava obstruction is most commonly related to an underlying malignancy and can result in significant morbidity and mortality. SVCS does not represent a true oncologic emergency in the vast majority of cases; however, it necessitates expedient management and prompt investigation for occult malignancy in patients who present with unknown history of cancer. SVCS does not affect the chance of cure of the underlying malignancy and should not change the overall treatment.

Oncologic Emergencies Part I: Pearls and Pitfalls

Thrombosis of the SVC accounts for the majority of nonmalignant causes of SVC syndrome, usually a result of an indwelling intravascular device. Post-radiation fibrosis and fibrosing mediastinitis are other causes.

Pearl of the Day: Superior Vena Cava Syndrome

chest X-ray -> mediastinal mass - CT chest with IV contrast to assess patency of SVC - MRI if patients cannot receive IV contrast

Superior Vena Cava Syndrome

Superior vena cava syndrome occurs when there is obstruction of venous blood flow through the SVC. SVC syndrome was originally described as being secondary to an infection, such as tuberculosis, or a syphilitic aortic aneurysm. In 60% of cases SVC syndrome is the symptomatic manifestation of malignant tumor growth, with small cell and non-small cell lung carcinomas being the most common malignancy found.

Superior Vena Cava Syndrome Review

In the pre-antibiotic era, infections (tuberculosis) were the most common cause of superior vena cava syndrome. By the 1980s, malignancy accounted for 90% of the cases of SVC syndrome. With the increase in the placement of catheters in the large vessels over recent decades, line-related thrombosis, vessel stenosis and other benign causes like fibrosing mediastinitis now account for an estimated 20-40% of cases of SVC syndrome.

Resources

Life in the Fastlane

Superior vena cava (SVC) obstruction impairs venous return through the SVC to the right atrium and has many causes, usually mediastinal masses or complications of SVC lines.

Endovascular Today

Endovascular therapy is being increasingly used as a rapid response to treatment-resistant tumors, benign thrombosis, and recurrent obstruction.

StatPearls

Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall.

WikEM

Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause.