Superior Vena Cava Syndrome

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Clinical-manifestations 4 Diagnostic-procedures 5 Complications 6 Management 7 More General Terms 8 Additional Terms 9 References

Introduction

• Obstruction of blood flow through the superior vena cava.

Etiology

• lung cancer, especially small cell carcinoma
• Hodgkin's lymphoma
• mediastinal fibrosis
• radiation fibrosis
• other mediastinal tumors

• thymoma
• germ cell tumor
• non-Hodgkin's lymphoma

Clinical-manifestations

• insidious onset
• dyspnea is the most common presenting symptom
• dysphagia
• cough
• chest pain
• prominent veins over the chest
• neck vein distention
• facial edema
• fullness of the head
• arm swelling
• stridor ( tracheal obstruction)

Diagnostic-procedures

• bronchoscopy has a high yield & is generally safe
• mediastinoscopy may be associated with excessive hemorrhage due to obstructed venous return

Complications

• tracheal obstruction

Management

• generally NOT regarded as a medical emergency
• generally MORE IMPORTANT to establish tissue diagnosis

• biopsy tissue external to obstructing mass
• if tissue biopsy unsuccessful at establishing diagnosis, bronchoscopy, mediastinoscopy, thoracotomy

• treatment directed at specific etiology

• radiation therapy (mainstay of treatment [2])
• chemotherapy

• endovascular stenting

• refractory disease
• rapid symptomatic improvement
• warfarin 1 mg daily with goal of INR < 1.6 ?? [3]

More General Terms

• syndrome

Additional Terms

• superior vena cava (SVC)

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 721
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
3. UpToDate 14.1 [1]
4. Superior Vena Cava Syndrome (PDQ) [2]

superior vena cava (SVC) syndrome