Superior Vena Cava Obstruction

Clinical Description

Extrinsic or Intrinsic blockage of the Superior Vena Cava resulting in upper body swelling, upper airway compromise, CNS signs, venous distension and collaterals in the neck and chest.

Caused by benign (e.g. TB, thrombus) and malignant causes. It becomes an emergency once tracheal compression and airway compromise established. Malignant causes include primary lung or mediastinal tumours e.g. Lung cancer, Lymphoma, Thymoma/Thymic carcinoma, metastatic disease to mediastinum e.g. breast cancer and germ cell tumours.

Investigations

• History and physical examination
• CXR: Apical/Mediastinal widening (unilateral: on the right and or bilateral)
• Contrasted CT Neck and Chest
• Biopsy: Bronchoscopy or CT guided if no obvious masses externally

Treatment

• Grade 3 and 4 (severe to life threatening symptoms): refer to surgery for SVC stenting + anticoagulation
• Surgery for chemotherapy or radiotherapy resistant tumours e.g. thymomas
• Chemotherapy +/- steroids after biopsy for chemo sensitive malignancies: Small cell lung cancer, Lymphoma, Germ Cell Tumours
• Radiotherapy: Chemotherapy resistant tumours or where surgery not possible