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ALL / Haematology
Superior vena cava obstruction
Superior vena cava obstruction
Superior vena cava (SVC) obstruction is an oncological emergency caused by compression of the SVC. It is most commonly associated with lung cancer.Features
- dyspnoea is the most common symptom
- swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
- headache: often worse in the mornings
- visual disturbance
- pulseless jugular venous distension
Causes
- common malignancies: small cell lung cancer, lymphoma
- other malignancies: metastatic seminoma, Kaposi's sarcoma, breast cancer
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis
Management is dependant on the individual patient and malignancy and advice should be taken from the oncology team. Options include:
- endovascular stenting is often the treatment of choice to provide symptom relief
- certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
- the evidence base supporting the use of glucocorticoids is weak but they are often given
+PassMedicine Notes
Superior vena cava (SVC) obstruction is an oncological emergency caused by compression of the SVC. It is most commonly associated with lung cancer.
Features- dyspnoea is the most common symptom
- swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
- headache: often worse in the mornings
- visual disturbance
- pulseless jugular venous distension
- common malignancies: small cell lung cancer, lymphoma
- other malignancies: metastatic seminoma, Kaposi's sarcoma, breast cancer
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis
- endovascular stenting is often the treatment of choice to provide symptom relief
- certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
- the evidence base supporting the use of glucocorticoids is weak but they are often given
