Superior Vena Cava Syndrome
Summary of Key Points
Etiology
• Superior vena cava (SVC) syndrome is usually due to a neoplastic process, predominantly primary lung carcinoma, with a disproportionate number of patients having small cell histology; non-Hodgkin lymphoma and metastatic tumors are the next most common.
• SVC syndrome can be iatrogenic; it is sometimes seen as a complication of a central venous line or cardiac surgery.
Evaluation
• A chest radiograph typically shows mediastinal widening; a mass is often seen in the region of the SVC.
• Small-dose cavograms can be safely accomplished to define the exact location and routes of collateral flow.
• Computed tomography scanning identifies the mass and collateral flow and is the most helpful study to guide treatment.
• Treatment of an identified mass before histologic diagnosis is rarely justified unless prior diagnosis is established.
• Methods used to define histology are sputum cytology, endobronchial ultrasound with and without bronchoscopy, lymph node biopsy, thoracentesis, percutaneous biopsy, and video-assisted mediastinoscopy or thoracotomy; these techniques are considered quite safe.
