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Superior Vena Cava Syndrome

Superior Vena Cava Syndrome is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Partial or complete obstruction of the superior vena cava (SVC) (1):
    • ~60% due to malignant causes
    • 20–40% thrombosis or nonmalignant causes
  • Usual course: acute; usually 2 to 4 weeks from onset of symptoms to diagnosis
  • Synonym(s): superior mediastinal syndrome; SVC obstruction

Epidemiology

  • Predominant age: all ages, less commonly children and young adults (16 to 30 years)
  • Predominant sex: male > female

Incidence
15,000 new cases per year in the United States (1)

Etiology and Pathophysiology

Obstruction of the SVC causes increased pressure of the venous system responsible for draining the upper chest and neck. This obstruction causes retrograde collateral flow and interstitial edema, which may result in the rapid development of cerebral edema, intracranial thrombosis, and death.

  • Malignancy
    • In adults, obstruction may be related to a primary tumor or lymph node metastasis (1).
      • Non–small cell lung cancer
      • Small cell lung cancer
      • Lymphoma
      • Metastatic lesions (most commonly from breast and testicular cancers)
  • Infections
  • Iatrogenic intravascular devices
  • Thyroid goiter
  • Thrombosis of SVC
  • Pericardial constriction
  • Idiopathic sclerosing mediastinitis
  • Aortic aneurysm
  • In children, most common after cardiac surgical procedures

Risk Factors

  • Uncontrolled primary cancer
  • History of mediastinal tumor
  • Previous invasive procedures
  • Intravascular devices

General Prevention

No preventive measures known

Commonly Associated Conditions

  • Malignancy:
    • Common: lung, lymphoma, and metastatic breast
    • Less common: germ cell tumors, thymoma, and mesothelioma
  • Hyperthyroidism
  • Infections: tuberculosis, histoplasmosis, syphilis

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Citation

Stephens, Mark B., et al., editors. "Superior Vena Cava Syndrome." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116581/0.5/Superior_Vena_Cava_Syndrome.
Superior Vena Cava Syndrome. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116581/0.5/Superior_Vena_Cava_Syndrome. Accessed June 24, 2019.
Superior Vena Cava Syndrome. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116581/0.5/Superior_Vena_Cava_Syndrome
Superior Vena Cava Syndrome [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116581/0.5/Superior_Vena_Cava_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Superior Vena Cava Syndrome ID - 116581 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116581/0.5/Superior_Vena_Cava_Syndrome PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -