Pearl of the Day: Superior Vena Cava Syndrome

Superior Vena Cava Syndrome Background - effect of elevated venous pressure in upper body that results from obstruction of venous blood flow through SVC - usually caused by external compression of SVC from mass, intravascular thrombosis - most common malignancies: lung, lymphoma - if compression occurs slowly, collateral vessels dilate to compensate for impaired flow - may cause neurological abnormalities from increased intracranial pressure

Signs/Symptoms - usually start 1 - 2 weeks after diagnosis - more common: facial swelling, dyspnea, cough, arm swelling - less common: hoarse voice, syncope, headache, dizziness - rare: visual changes, dizziness, confusion, seizures, obtundation

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

Management - head elevation to decrease venous pressure - supplemental oxygen to reduce work of breathing - indwelling central venous catheter -> remove - lymphoma suspected -> corticosteroids (very limited evidence in other cases) - cerebral/airway edema present -> loop diuretics, though also very limited evidence - treatment: radiation therapy (can improve symptoms within 3 days), intravascular stents, chemotherapy, catheter-directed fibrinolytics (if secondary to intravascular thrombosis)

Resources Tintinalli's Emergency Medicine, 8th Edition Lepper PM, Ott SR, Hoppe H, et al. Superior Vena Cava Syndrome in Thoracic Malignancies. American Association for Respiratory Care. Published May 1, 2011. Accessed April 27, 2018.