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Superior Vena Cava Syndrome in Emergency Medicine Treatment & Management

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

Prehospital Care

Prehospital caregivers are aware of the superior vena cava syndrome (SVCS) diagnosis only on occasion.

The usual attention to airway, breathing, and circulation (ABCs) is required.

Superior vena cava syndrome only rarely manifests as a life-threatening entity; therefore, other causes for the symptomatology must be sought.

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Emergency Department Care

Superior vena cava syndrome only rarely manifests as an acute emergency. Typically, the syndrome develops over weeks to months and is recognized when the typical signs of facial and upper extremity edema occur. Confusion related to associated cerebral edema or stridor from laryngeal edema and impending airway obstruction represent acute emergencies.

Attention to the ABCs is essential.

If patients are allowed to sit upright, they may experience some relief of the usual dyspnea.

Stabilize the airway, as needed, and consider steroids.

If cerebral/airway edema is present, consider diuretics; however, diuretics have not shown consistent benefit in the emergency department (ED).

Endovascular shunts are increasingly used, as are thrombolytics if a thrombotic cause is present.

After a tissue diagnosis, radiation and chemotherapy may be initiated.

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Consultations

Over the last 10 years, considerable experience with endovascular stenting of superior vena cava syndrome has been achieved.[4, 5] At many centers, endoprostheses have become the initial choice for palliative treatment of superior vena cava syndrome.

Emergent consultation with radiation therapy may be necessary, depending upon the acuteness of the presentation.

Because most causes of superior vena cava syndrome are related to lung cancer, a pulmonary or oncology consultation may be obtained.

Generally, considering the diagnosis in the ED is important. If the diagnosis is made de novo in the ED, only rarely is emergent consultation necessary. Exceptions include sudden airway compromise or acute superior vena cava thrombosis, which may occur from an indwelling catheter.

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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
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  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].

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  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].

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  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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