SVC obstruction
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Definition
SVC obstruction is a narrowing or blockage of the superior vena cava -- the second largest vein in the human body. The superior vena cava moves blood from the upper half of the body to the heart.
Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome
Causes, incidence, and risk factors
Superior vena cava (SVC) obstruction is a relatively rare condition.
Most often it is caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs).
The types of cancer that can lead to this condition include:
Breast cancer
Lymphoma
Testicular cancer
Thyroid cancer
Thymic tumors
Superior vena cava obstruction can also be caused by noncancerous conditions that cause scarring. These conditions include:
Other causes of superior vena cava obstruction include:
Catheters placed in the large veins of the upper arm and neck may cause blood clots in the superior vena cava.
References
Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42.
Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-1869.
Ugras-Rey S, Watson M. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 121.
Review Date: 1/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome
Symptoms
Symptoms occur when something blocks the blood flowing back to the heart. They may begin suddenly or gradually, and may worsen when you bend over or lie down.
Early signs include:
The swelling will most likely be worse in the early morning hours and go away by mid morning.
The most common symptoms are shortness of breath (dyspnea) and swelling of the face, neck, trunk, and arms.
Other possible symptoms inclue:
- Decreased alertness
- Dizziness
- Fainting
- Headache
- Reddish face or cheeks
- Reddish palms
- Reddish mucus membranes (inside the nose, mouth, and other places)
- Redness changing to blueness later
- Sensation of head or ear "fullness"
- Vision changes
Signs and tests
An examination may show enlarged veins of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.
A bronchoscopy (a lighted tube placed through the mouth into the windpipe and lungs) may be performed if lung cancer is suspected.
Blockage of the SVC may be visible on:
This disease may also affect the results of the following tests:
References
Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42.
Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-1869.
Ugras-Rey S, Watson M. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 121.
Review Date: 1/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome
Treatment
The goal of treatment is to relieve the blockage.
Diuretics ("water pills") or steroids may be used to relieve swelling.
Other treatment options may include radiation or chemotherapy to shrink the tumor, or surgery to remove the tumors. 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 amount of blockage.
SVCS caused by a tumor is a sign that the tumor has spread, and it indicates a poorer long-term outlook.
Complications
The throat could become blocked, which can block the airways.
Increased pressure may develop in the brain, leading to changed levels of consciousness, nausea, vomiting, or vision changes.
Calling your health care provider
Call your health care provider if you develop symptoms of SVC obstruction. Complications are serious and can sometimes be fatal.
References
Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42.
Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-1869.
Ugras-Rey S, Watson M. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 121.
Review Date: 1/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome
Prevention
Prompt treatment of other medical disorders may reduce the risk of developing SVC obstruction.
References
Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42.
Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-1869.
Ugras-Rey S, Watson M. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 121.
Review Date: 1/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 1/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.