Superior vena cava syndrome (SVCS) develops from obstruction of venous drainage from the upper body, resulting in increased venous pressure, which leads to dilation of the collateral circulation. SVCS is most commonly caused by vascular compression from malignant mediastinal tumors. Dyspnea; swelling of the face, upper extremities, and trunk; chest pain; cough; or headache may be present. Physical findings include dilation of collateral veins of the trunk and upper extremities, facial edema and erythema (plethora), cyanosis, and tachypnea.
Superior Vena Cava Syndrome. A 27-year-old man with SVCS. Note the prominent collateral veins of the chest and neck. (Photo contributor: William K. Mallon, MD.)
Superior Vena Cava Syndrome. A middle-aged woman with plethora, distended superficial upper thorax veins, and headache with SVCS due to lymphoma.
Management and Disposition
Radiation therapy is the initial treatment for most malignant mediastinal tumors causing SVCS. An exception is small cell carcinoma, which responds better to chemotherapy. Elevating the head of the bed, oxygen, and administration of corticosteroids and diuretics initiated in the ED may provide temporary relief pending definitive therapy.
SVCS is most commonly caused by malignant mediastinal tumors.
Treatment of most mediastinal tumors causing SVCS is radiation therapy.
Contrast-enhanced CT scan of the chest is the diagnostic study of choice for patients with SVCS.
Signs of decreased cardiac output, cerebral edema, and laryngeal edema are life-threatening findings in patients with SVCS.
Facial Plethora. A 53-year-old woman presents with shortness of breath and facial plethora. She has SVCS due to lung cancer. (Photo contributor: R. Jason Thurman, MD.)