Superior Vena Cava Syndrome

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How is superior vena cava syndrome diagnosed?

  • A plain chest x-ray may show abnormal enlargement of the mediastinum or may reveal a tumor in the lung.
  • Ultrasound may be used to look for blood clots in the arm leading into the chest.
  • Computerized tomography (CT) scanning of the chest is most often used to diagnose superior vena cava syndrome. While it will show the blockage and may show a tumor, it will not necessarily diagnose the type of tumor.
  • If a tumor is the cause of the obstruction, often a surgical procedure will be required to obtain a biopsy (a small piece of tissue), to help make the specific diagnosis as to the type of tumor.

How is superior vena cava syndrome treated?

Rarely does superior vena cava syndrome constitute a medical emergency. The ABCs of care are always a priority, insuring that the Airway is well maintained, Breathing is adequate and the Circulation (blood pressure and heart rate) is stable. The patient may feel more comfortable in an upright position. Furosemide (Lasix) is a diuretic that will decrease the volume of fluid within the bloodstream. With less pressure pushing against the obstructed superior vena cava, symptoms may be temporarily relieved.

Treatment needs to be directed to the underlying cause.

If the cause is a tumor or cancer, the treatment plan will need to be customized to the patient's condition and desires. Options include radiation with or without chemotherapy. Even with aggressive treatment with radiation, only 10 % of lung cancer patients with this syndrome survived to 30 months. Without any treatment, survival may be less than a month.

Steroids [for example, methylprednisolone (Medrol, Depo-Medrol) or prednisone (Deltasone, Liquid Pred)], may be considered to decrease the swelling of a tumor pressing on the superior vena cava and help relieve symptoms.

If the cause of superior vena cava syndrome is a blood clot, anticoagulation with (warfarin) Coumadin may be indicated. The use of thrombolytic drugs [for example, alteplase (Activase, TPA) or TNK] to break up the clot, or placement of a stent to keep the vein open may also be considered.

Special consideration

In children, superior vena cava syndrome is most often caused bynon-Hodgkin's lymphoma. The compression of the superior vena cava may be associated with compression of the trachea as well. The trachea (windpipe) in children is relatively narrow, flexible, and soft as compared with an adult. Airway obstruction may occur and manifest as:

  • difficulty breathing,
  • stridor (high-pitched, abnormal breathing sounds heard when breathing in), and
  • wheezing.
Medically Reviewed by a Doctor on 9/8/2016

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