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Superior Vena Cava Syndrome in Emergency Medicine Follow-up

  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Dec 16, 2014
 

Complications

Total superior vena cava (SVC) obstruction is rare. Potential causes include indwelling catheters. Thrombolysis must be considered.

Airway compromise is unusual but may result from extrinsic compression of the superior vena cava or the trachea by the tumor mass.

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Prognosis

Superior vena cava syndrome (SVCS) is associated with malignancy. The prognosis for relief of superior vena cava syndrome symptoms is good with radiation therapy. Symptoms usually decrease within 1 month of the onset of radiation therapy. However, the ultimate prognosis is associated with the underlying malignancy itself.

The prognosis for superior vena cava syndrome not associated with malignancy is excellent because most of these causes are infectious and respond to appropriate antibiotic therapy.

Recently, management of superior vena cava syndrome by internal jugular to femoral vein bypass has been described.[6] This may help improve symptoms of patients with malignancy.

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Contributor Information and Disclosures
Author

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Canadian Association of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg. 1990 Aug. 160(2):207-11. [Medline].

  2. Thakker M, Keteepe-Arachi T, Abbas A, Barker G, Ruparelia N, Kingston GT, et al. A primary cardiac sarcoma presenting with superior vena cava obstruction. Am J Emerg Med. 2012 Jan. 30(1):264.e3-5. [Medline].

  3. Andersen PE, Duvnjak S. Palliative treatment of superior vena cava syndrome with nitinol stents. Int J Angiol. 2014 Dec. 23(4):255-62. [Medline]. [Full Text].

  4. Lanciego C, Pangua C, Chacon JI, et al. Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. AJR Am J Roentgenol. 2009 Aug. 193(2):549-58. [Medline].

  5. Sato Y, Inaba Y, Yamaura H, Takaki H, Arai Y. Malignant inferior vena cava syndrome and congestive hepatic failure treated by venous stent placement. J Vasc Interv Radiol. 2012 Oct. 23(10):1377-80. [Medline].

  6. Dhaliwal RS, Das D, Luthra S, et al. Management of superior vena cava syndrome by internal jugular to femoral vein bypass. Ann Thorac Surg. 2006 Jul. 82(1):310-2. [Medline].

  7. [Guideline] Kvale PA, Selecky PA, Prakash UB. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep. 132(3 Suppl):368S-403S. [Medline].

  8. Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest. 1993 Apr. 103(4 Suppl):394S-397S. [Medline].

  9. Armstrong BA, Perez CA, Simpson JR, Hederman MA. Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys. 1987 Apr. 13(4):531-9. [Medline].

  10. Baker GL, Barnes HJ. Superior vena cava syndrome: etiology, diagnosis, and treatment. Am J Crit Care. 1992 Jul. 1(1):54-64. [Medline].

  11. Bauset R. Pacemaker-induced superior vena cava syndrome: a case report and review of management strategy. Can J Cardiol. 2002 Nov. 18(11):1229-32. [Medline].

  12. Courtheoux P, Alkofer B, Al Refai M, et al. Stent placement in superior vena cava syndrome. Ann Thorac Surg. 2003 Jan. 75(1):158-61. [Medline].

  13. Lanciego C, Chacon JL, Julian A, et al. Stenting as first option for endovascular treatment of malignant superior vena cava syndrome. AJR Am J Roentgenol. 2001 Sep. 177(3):585-93. [Medline].

  14. Leggio L, Abenavoli L, Vonghia L, et al. Superior vena cava thrombosis treated by angioplasty and stenting in a cirrhotic patient with peritoneovenous shunt. Ann Thorac Cardiovasc Surg. 2008 Feb. 14(1):60-2. [Medline].

  15. Link MS, Pietrzak MP. Aortic dissection presenting as superior vena cava syndrome. Am J Emerg Med. 1994 May. 12(3):326-8. [Medline].

  16. Madan AK, Allmon JC, Harding M, et al. Dialysis access-induced superior vena cava syndrome. Am Surg. 2002 Oct. 68(10):904-6. [Medline].

  17. Queen JR, Berlin J. Superior vena cava syndrome. J Emerg Med. 2001 Aug. 21(2):189-91. [Medline].

  18. Wan JF, Bezjak A. Superior vena cava syndrome. Emerg Med Clin North Am. 2009 May. 27(2):243-55. [Medline].

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Patient with a 4-week history of increasing facial edema and known lung cancer.
Chest radiograph of a patient with known superior vena cava syndrome (SVCS) and bronchogenic carcinoma (CA).
Chest radiograph of a 50-year-old woman with complaint of shortness of breath and facial swelling. No previous history of cancer but 30 pack-year history.
CT scan of the same 50-year-old woman in Image 3 with an initial presentation of shortness of breath and facial swelling. This shows a large tumor mass in the right mediastinum nearly surrounding the right main stem bronchus and partially occluding the superior vena cava.
 
 
 
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