History
Early in the clinical course of superior vena cava (SVC) syndrome (SVCS), signs or symptoms may be subtle or absent. 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:
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Facial swelling
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Cough
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Orthopnea
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Headache
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Nasal stuffiness
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Light-headedness
Neurologic symptoms, such as dizziness and confusion, are late findings as cerebral edema occurs.
Physical Examination
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).
Superior Vena Cava Syndrome in Emergency Medicine. Patient with a 4-week history of increasing facial edema and known lung cancer.
The degree of jugular venous distention varies but often progresses through the course of disease.
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.
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Superior Vena Cava Syndrome in Emergency Medicine. Patient with a 4-week history of increasing facial edema and known lung cancer.
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Superior Vena Cava Syndrome in Emergency Medicine. Chest radiograph of a patient with known superior vena cava syndrome (SVCS) and bronchogenic carcinoma (CA).
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Superior Vena Cava Syndrome in Emergency Medicine. 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.
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Superior Vena Cava Syndrome in Emergency Medicine. CT scan of the same 50-year-old woman in the previous image 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.
