Superior vena cava syndrome: Difference between revisions

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==Pathophysiology==
==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


Occurs in 3-8%  with lung cancer and lymphoma
==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]]


Symptoms due to venous hypertension in areas drained by SVC
==Differential Diagnosis==
{{Facial swelling DDX}}


Deaths occurs from cerebral edema, airway compromise, or cardiac compromise
{{Oncologic emergencies DDX}}


==Clinical features==
==Evaluation==
 
[[File:SVC_syndrome.jpg|thumb|CT chest showing right lung tumor compressing SVC]]
 
*CT with IV contrast
Thoracic or neck vein distention - 65%
**Recommended imaging modality (assesses patency of the SVC, evaluate etiology mass vs. thrombus)
 
*[[CXR]]
Shortness of breath - 50%
**Shows mediastinal mass or parenchymal lung mass (10% of patients)
 
Tachypnea - 40%
 
Upper trunk or extremity edema - 40%
 
Cough/dysphagia/chest pain - 20%
 
Peri-orbital or facial edema - ?
 
Stroke's sign (tight shirt collar) - ?
 
==Diagnosis==
 
 
CXR shows mediastinal mass or paranchymal lung mass in 10%
 
CT is diagnostic


==Management==
==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


Furosemide 40mg IV
==References==
 
<references/>
Methylprednisolone 1-2 mg/kg IV
 
Mediastinal radiation
 
 
===Source===
 
 
Sotelo 10/09
 
 
 


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 04:47, 8 January 2022

Background

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[1]
  • Rarely constitutes an emergency

Risk Factors

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

Clinical Features

SVC syndrome with classic symptoms, including obvious face, neck, and upper trunk swelling.

Differential Diagnosis

Facial Swelling

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Evaluation

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[2]
  • Corticosteroids and loop diuretics have questionable efficacy and should be held until ordered by admitting team[3]
  • Intravascular stent, consult IR
  • If malignancy
    • Mediastinal radiation, consult oncology/radiation oncology
  • If thrombus

Disposition

  • Admit to ICU, with plan for airway monitoring and tissue biopsy

References

  1. ↑ Nickloes TA, Lopez Rowe V, Kallab AM, Dunlap AB (28 March 2018). "Superior Vena Cava Syndrome". Medscape
  2. ↑ 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.
  3. ↑ 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.
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