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SVC Syndrome

What is SVC syndrome

Pathophysiology

Superior vena cava (SVC) syndrome occurs when blood flow through the SVC becomes obstructed due to external compression or internal occlusion by tumor invasion, fibrosis, or an intraluminal thrombus. This subsequently impairs venous drainage from the head, neck, upper extremities, and thorax. Decreased venous return to the heart, in turn, causes decreased cardiac output, increased venous congestion, and edema.

*Bethesda Handbook of Oncology

Causes

Etiology

Malignant (> 90% of cases)

  • Lung Cancer (Squamous and Small Cell)
  • Lymphoma
  • Metastatic Disease
  • Thymomas (< 2 %)
  • Germ cell tumors (< 2%)

Benign

  • Intravascular Device (central line or pacemaker)
  • Retrosternal goitre
  • Sarcoidosis
  • TB
  • Fibrosing Mediastinitis
  • Post Radiation Fibrosis

*Bethesda Handbook of Oncology

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Clinical

Symptoms
  • Dyspnea (> 63%)
  • Facial Swelling or feeling head fullness (50%)
  • Cough, chest pain and dysphagia are less common
  • Severe Cases
    • Confusion, Altered mental state (severe cases)
    • Visual disturbances secondary to occular edema
    • Stridor from laryngeal edema

*Bethesda Handbook of Oncology

Clinical Signs

Characteristic physical examination findings include:

  • venous distention of neck (66%),
  • venous distention of chest wall (54%)
  • facial edema (46%).
  • Other examination findings may include:
    • cyanosis,
    • arm swelling,
    • facial plethora
    • edema of arms.

Symptoms are generally exacerbated by bending forward, stooping, or lying down.

*Bethesda Handbook of Oncology

Diagnosis

Modality
  • Clinical
  • CT with venogram
  • Biopsy
    • Percutaneous
    • EBUS
    • Thoracotomy

*Bethesda Handbook of Oncology

PEARLS
  • It has been shown that radiation prior to obtaining tissue diagnosis impedes accurate interpretation of the biopsy sample in >50% of cases
  • Depending on the cause consult:
    • Thoracic Surgery on-call
    • Radiation Oncology on-call
    • Medical Oncology on-call

*Bethesda Handbook of Oncology

Other resources

Last Update: August 19, 2024

Table of Contents

Spinal Cord Compression

Spinal cord compression (SCC) is a true oncologic emergency as delays in diagnosis can cause severe, irreversible neurologic compromise, decline in functional status, and impaired quality of life. SCC affects roughly 3% to 5% of all patients with cancer. The majority of cases result from spine metastases with extension into the epidural space. It is the second most frequent neurologic complication of cancer after brain metastases. The median overall survival of patients with SCC ranges from 3 to 16 months and most die of systemic tumor progression.

Raised ICP

The contents of our skull and dura can be divided into three main compartments: brain parenchyma (which occupies a volume of approximately 1.4 L), spinal fluid (52-160 mL), and blood (150 mL). An increase in any of these three compartments, as per the Monro-Kellie hypothesis, will occur at the expense of the remaining two. In addition, intracranial compliance has been noted to decrease with rising pressure, thus causing further compromise in cerebral perfusion. The normal range of ICP has been reported to be 5 to 15 mm Hg.

SVC Syndrome

Superior vena cava (SVC) syndrome occurs when blood flow through the SVC becomes obstructed due to external compression or internal occlusion by tumor invasion, fibrosis, or an intraluminal thrombus. This subsequently impairs venous drainage from the head, neck, upper extremities, and thorax. Decreased venous return to the heart, in turn, causes decreased cardiac output, increased venous congestion, and edema.

Chest Tubes

In this episode of our emergency and critical care procedures series we take a look at how to insert a tube thoracostomy. In this real case Dr Chris Moseley and Dr Andy Steval talk you through how to do this critical procedure in a real patient with a haemothorax.
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