Superior Vena Cava Syndrome

Diagnosis: dx is clinical signs and symptoms of central venous obstruction, with supportive radiographic findings.
--most common symptoms: dyspnea>>facial swelling/fullness>>arm edema, cough, chest pain
--PE is notable for facial edema and venous distension in the neck and chest
--most useful imaging study is CT chest w contrast; venography is the gold standard for deliniating vascular pattern, but does not give a clear idea of the cause of the SVC compression; MR is an alternative option in pt's who cannot tolerate contrast
--in this pt, he had a new cardiac murmur, which on echo showed some LVOT obstruction from extrinsic compression

Treatment:
--urgency of treatment depends of clinical symptoms; alarming symptoms include significant cerebral edema (confusion, obtundation), laryngeal edema (stridor) or significant hemodynamic compromise (syncope, hypotension, ie. low output heart failure)
--treatment also depends greatly on the underlying disease process--high grade lymphomas can respond well to steroids alone; small cell lung cancer does not.  Both malignancies are very responsive to chemotx. Endovascular stenting, surgical decompression and XRT are other tx options, depending on the clinical context   
--minimal data for steroids improving laryngeal edema, some data for diuresis (but not in this patient!)
--if the source of venous obstruction is a thrombosis, tx is anticoagulation/antiplatelet tx

(Victoria Kelly MD, 6/11/10)