Superior Vena Cava Obstruction

Background

  • Oncological emergency caused by obstruction of the superior vena cava
  • Can be caused by
    • Intrinsic causes e.g.
      • DVT (often acute onset)
      • Foreign body e.g. line
      • Tumour within the vessel e.g. renal cancer
    • Extrinsic causes, usually by cancer e.g.
      • Lung cancer (80%) (usually SCLC)
      • Lymphoma (10%)
      • Other malignancy (5%)
      • Benign causes (5%)
        • Aneurysm, goitre, fibrosis, infection

Presentation

  • Swelling of the face, neck and/or upper limb(s)
  • Distended veins (neck veins don’t collapse)
  • Shortness of breath
  • Headache and lethargy can also occur but are not as characteristic

Investigations

  • CXR- mass? +/- CT
    • If mass, try and obtain tissue (FNA; scope biopsy)
  • Venogram- clot?

Management

  • Clot
    • Local thrombolysis with streptokinase
    • Anti-coagulation- heparin (IV or LMWH) for 5/7 whilst initiating warfarin
  • Extrinsic causes
    • Steroids
    • Chemotherapy (if responsive)
    • Radiotherapy
    • Stent can provide rapid relief but will not treat the underlying cause
      • May allow time to diagnose the underlying cause
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