7-16: Superior Vena Cava Syndrome

Clinical Summary

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.

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.

Pearls

1. SVCS is most commonly caused by malignant mediastinal tumors.

2. Treatment of most mediastinal tumors causing SVCS is radiation therapy.

3. Contrast-enhanced CT scan of the chest is the diagnostic study of choice for patients with SVCS.

4. Signs of decreased cardiac output, cerebral edema, and laryngeal edema are life-threatening findings in patients with SVCS.