SVC obstruction

Alternative names
Superior vena cava obstruction; Superior vena cava syndrome

Definition
SVC obstruction is a narrowing or obstruction of the superior vena cava - the major vein draining the upper body.

Causes, incidence, and risk factors

Superior vena cava (SVC) obstruction is a relatively rare condition. Most often it is caused by one of several cancers that can be found in the mediastinum (the area of the chest under the breastbone and between the lungs).

These include lymphomas, cancer of the lung with extension into the mediastinum, Breast cancer, Testicular cancer, Thyroid cancer, and thymic tumors. Superior vena cava obstruction can also be caused by noncancerous conditions that cause chronic fibrosis (scarring).

These include lung infections, such as Tuberculosis, histoplasmosis infection, and thrombophlebitis (particularly extension of thrombophlebitis of superficial veins or the subclavian vein). Other causes of superior vena cava obstruction include aortic aneurysm, constrictive pericarditis, and goiter.

Symptoms

     
  • neck swelling, facial swelling, or arm swelling  
  • swelling around the eye socket (periorbital)  
  • sensation of head or ear “fullness”  
  • reddish face or cheeks  
  • reddish palms  
  • reddish mucous membranes (inside the nose, mouth, and so on)  
  • redness changing to blueness later  
  • headache  
  • dizziness  
  • vision changes  
  • fainting  
  • decreased alertness

Note: Symptoms may begin suddenly or gradually, and may worsen when bending over or lying down.

Signs and tests

An examination may show dilated cutaneous (skin) veins of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.

A bronchoscopy may be performed if lung cancer is suspected.

Obstruction of the SVC may show on:

This disease may also alter the results of the following tests:

Treatment

The goal of treatment is relief of the obstruction.

Diuretics may be used to relieve swelling.

The cause must be identified and treated. This may include radiation, Chemotherapy, surgical removal of tumors, or other treatment. Surgery to bypass the obstruction is rarely performed. Placement of a stent to open up the SVC is available at some medical centers.

Expectations (prognosis)
The outcome varies depending on the cause and the extent of obstruction.

Complications
The throat could swell and block the airways.

Calling your health care provider
Call your health care provider if a lung tumor is present and symptoms indicate SVC obstruction may be present. Complications are serious and can sometimes be fatal.

Prevention
Prompt treatment of causative disorders may reduce the risk of development of SVC obstruction.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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