Superior Vena Cava Syndrome in Emergency Medicine Clinical Presentation
- Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Erik D Schraga, MD more...
Early in the clinical course of superior vena cava (SVC) syndrome (SVCS), few, if any, signs or symptoms may be observed. Typically, symptoms accelerate as the underlying malignancy increases in size and/or invasiveness. Dyspnea is the most common symptom, followed by trunk or extremity swelling. Other symptoms include the following:
Neurologic symptoms, such as dizziness and confusion, are late findings as cerebral edema occurs.
Physical examination often reveals facial or upper extremity edema. The degree of facial edema has been described as facial engorgement (as is seen in the image below).
The degree of jugular venous distention varies.
Other markers of lung malignancy, such as Horner syndrome, paralysis of the vocal cords, and paralysis of the phrenic nerve, are rarely present.
Stridor may occur as the syndrome progresses and airway obstruction occurs.
Today, the most common etiology of superior vena cava syndrome is related to malignancy.
Prior to modern antibiotics, infectious causes including syphilis, tuberculosis, and fungi occurred with almost equal frequency.
The most common cause of malignancy-related superior vena cava syndrome is bronchogenic carcinoma, which accounts for nearly 80% of cases.
Lymphoma accounts for approximately 15% of cases.
Other cases have various causes, including infectious and catheter-related etiologies. Increasingly, dialysis catheters and pacemaker leads are becoming associated with superior vena cava syndrome due to thrombosis.
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