Obstruction of the superior vena cava reduces venous return from the head, neck, and upper extremities. About 85% of cases are due to lung cancer; lymphoma and thrombosis of central venous catheters are also causes. Pts often present with facial swelling, dyspnea, and cough. In severe cases, the mediastinal mass lesion may cause tracheal obstruction. Dilated neck veins and increased collateral veins on anterior chest wall are noted on physical examination. Chest x-ray (CXR) documents widening of the superior mediastinum; 25% of pts have a right-sided pleural effusion.
Treatment: Superior Vena Cava Syndrome Radiation therapy is the treatment of choice for non-small-cell lung cancer; addition of chemotherapy to radiation therapy is effective in small-cell lung cancer and lymphoma. Symptoms recur in 10-30% and can be palliated by venous stenting. Clotted central catheters producing this syndrome should be removed and anticoagulation therapy initiated. |
Section 2. Medical Emergencies