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Clinical Pearl

Diagnosing Superior Vena Cava Syndrome

doi: 10.1097/01.EEM.0000522220.37441.d2
Clinical Pearl

BY EMEDHOME.COM

Superior vena cava syndrome occurs when the SVC is extrinsically compressed or occluded. Thoracic malignant disorders are the most common cause, but SVCS also can be caused by SVC thrombosis and stenosis secondary to indwelling venous lines or pacemaker leads.

Highly proliferative tumors and SVC thrombosis can result in rapid onset of symptoms. The most common physical findings are facial, neck, and arm swelling and dilated veins in the chest. CT with IV contrast is used to confirm the diagnosis of SVCS; MRI is helpful in cases in which IV contrast is contraindicated. SVCS is commonly considered an oncological emergency, but most SVCS cases are not. (Mayo Clin Proc 2017;92[4]:609.)

Endovascular stenting of the SVC can promptly relieve symptoms, and is the treatment of choice in very symptomatic patients. Radiation therapy (RT) is effective for many patients, but symptom relief may be slow. Tissue diagnosis should be established before initiating RT. Glucocorticoids relieve symptoms of SVCS from lymphoma, but should not be given until the diagnosis has been established by biopsy because corticosteroids may obscure the diagnosis.

Corticosteroids have no role in SVCS secondary to lung cancer or other causes. Anticoagulation is reserved for SVC thrombosis. Catheter-directed thrombolysis can be useful in SVCS secondary to a thrombus. (Am J Kidney Dis 2017;69[2]:309.)

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