Medication Summary
Steroids and diuretics have been the mainstays of ED management. However, superior vena cava syndrome (SVCS) rarely presents as an acute life-threatening emergency. As such, considering the diagnosis may be more important than the actual definitive care when making therapeutic decisions.
Glucocorticoids
Class Summary
These agents decrease the inflammatory response to tumor invasion and edema surrounding the tumor mass. They have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Methylprednisolone (Solu-Medrol, Depo-Medrol, Medrol)
One of several steroids that may be given in ED. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Prednisone (Deltasone, Orasone, Sterapred)
Useful in treatment of inflammatory and autoimmune reactions. By reversing increased capillary permeability and suppressing polymorphonuclear neutrophil (PMN) activity, may decrease inflammation.
Diuretics
Class Summary
These agents may decrease venous return to the heart by decreasing preload, relieving the increased pressure in the superior vena cava.
Furosemide (Lasix)
Increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule.
Dose must be individualized. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after previous dose, until desired diuresis occurs. When treating infants, titrate with 1 mg/kg/dose increments until satisfactory effect achieved.
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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.
