Daily Bolus of LR: Superior Vena Cava Syndrome

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October 27, 2011 by dailybolusoflr

Superior Vena Cava Syndrome

 

This syndrome involves a constellation of signs and symptoms that are often quite prominent but rarely require any immediate emergent intervention.

 

·         Compression of the SVC can result from a mass in the middle or anterior mediastinum or from thrombosis of the vessel itself

·         Symptoms depend on the severity of obstruction as well as the rapidity of onset

·         The most common malignant etiologies are lung cancers and lymphoma

·         The most common non malignant etiology is thrombosis from an intravascular device such as a pacemaker

·         The most common signs and symptoms at presentation include (in order or most frequent to least frequent): facial edema, distended neck veins, distended chest veins, cough and dyspnea, arm edema, hoarseness, syncope, headaches, dizziness, confusion, stridor, AMS and visual symptoms

o   The earliest sign might be mild facial edema early in the morning that resolves over the first few hours of the day

·         Evaluation typically involves CT of the chest to delineate whether there is an intrinsic or extrinsic process involved

·         Simple measures such as elevating the head of the bed and supplemental oxygen can assist with symptom control

·         Use of steroids or diuretics have been discussed but have not shown to be of any significant benefit.  They would  probably still be recommended in critical situations such as cerebral edema or laryngeal edema.  Clearly these patients should be treated as you would for any other patient with cerebral edema and with airway protection for patients with compromise of their airway

·         Anticoagulation for thrombosis also offers unclear benefit

·         The definitive therapy is radiation, chemo or stenting/surgery

 

 

Pubmed citation here http://www.ncbi.nlm.nih.gov/pubmed/19447309

Ref: Emerg Med Clin North Am. 2009 May;27(2):243-55. and N Engl J Med 2007; 356:1862-1869

 

 

 

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