Jan 15, 2020
Join the EMGuideWire team as they discuss
Superior Vena Cava Syndrome!
- Any condition leading to obstruction of blood flow through the
- Pathology in adjacent anatomy (lung, lymph node, thymus,
mediastinum) or within the SVC itself obstructs venous return to
the right atrium. As the SVC is compressed, venous collaterals form
alternative pathways returning blood to the right atrium which can
dilate over several weeks. As a result, upper body venous pressure
increases, which in extreme cases lead to airway congestion and
venous cerebrovascular congestion and edema. Hemomdynamic
compromise is most often by direct compression of the heart, not
from SVC obstruction.
- Indwelling device through the SVC (Central line, dialysis
- Lung cancer
- Signs – plethoric appearance, dilated neck and chest veins,
- Symptoms – congestive symptoms (head fullness, swelling),
cardiopulmonary symptoms (chest pain, dyspnea, stridor,
hoarseness), and neurologic symptoms (headache, confusion,
obtundation, visual disturbances)
- Is the patient unstalbe? Do they have severe SVC?
- If yes, secure airway, support breathing, support
- Consult vascular/cardiothoracic surgery
- If patient is stable, then:
- Confirm diagnosis and evaluate for malignant obstruction
- CBC, CMP, PT/INR, CXR, CT chest w/contrast
- Does the patient have a malignant obstruction or thrombosis?
- Yes -> consult heme/onc and admit
- No -> observe in ED
García Mónaco R, Bertoni H, Pallota G, et al. Use of self-expanding
vascular endoprostheses in superior vena cava syndrome. Eur J
Cardiothorac Surg 2003; 24:208.
Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome:
clinical characteristics and evolving etiology. Medicine
(Baltimore) 2006; 85:37.
Schraufnagel DE, Hill R, Leech JA, Pare JA. Superior vena caval
obstruction. Is it a medical emergency? Am J Med 1981;
Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior
vena cava syndrome with malignant causes. N Engl J Med 2007;