Superior vena cava syndrome

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Background

  • External compression by extrinsic malignant mass causes majority of cases
  • Thrombus in SVC from indwelling catheter/pacemaker is increasingly more common as cause
  • Infection
  • 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, decreased cardiac output

Risk Factors

  • Lung Cancer
  • Lymphoma
  • Indwelling vascular catheters (increasing incidence)
  • Thrombotic coagulopathy
  • Goiter
  • TB
  • Radiation
  • Pericardial constriction

Clinical Features

Differential Diagnosis

Facial Swelling

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Evaluation

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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 paranchymal 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[1]
  • Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team[2]
  • Intravascular stent
  • If malignancy
    • Mediastinal radiation
  • If thrombus
    • Anticoagulation, catheter removal, consider thrombolytics

References

  1. 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.
  2. 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.