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Superior vena cava syndrome (SVCS)

Superior vena cava syndrome (SVCS)
Superior vena cava syndrome (SVCS)


Superior vena cava syndrome (SVCS) is the clinical expression for obstruction of blood flow through the SVC. Malignancy (90%) is the most frequent cause of SVC obstruction. SVC obstruction is a strong predictor of poor prognosis in patients with non–small cell lung cancer. SVC obstruction in cancer patients can result from
Extrinsic compression of SVC
• Lung Cancer (65%)
•Lymphomas (15%)
• Other cancers (10%)
Intrinsic compression

Signs and Symptoms

Diagnostic criteria

Common symptoms and physical findings of SVCS are:

• dyspnea
• headache
• oedema and change in colour in the areas drained by SVC(examples–face and upper limb)
• venous distension of neck, upper chest and arms
• cough
• Pemberton’s sign (development of facial flushing, distended neck and head superficial veins, inspiratory stridor and elevation of the jugular venous pressure (JVP) upon raising both of the patient's arms above his/her head simultaneously, as high as possible (Pemberton's maneuver)


• CT scan Chest Abdomen and Pelvis
• Tissue diagnosis for appropriate treatment modality


  • Pharmacological

    Supportive measures

    • Head elevation–To decrease the hydrostatic pressure and thereby the edema. There are no data documenting the effectiveness of this manoeuvre, but it is simple and without risk.

    • Glucocorticoid therapy (dexamethasone, 4 mg every 6 h) to relieve inflammation and oedema (to be avoided before biopsy if lymphoma is suspected as steroid induced tissue necrosis might obscure the diagnosis)

    • Loop diuretics (Furosemide) are also commonly used, but it is unclear whether venous pressure distal to the obstruction is affected by small changes in right atrial pressure.

    Definitive Therapy

    • Radiation treatment to the malignant mass.
    • Chemotherapy–in chemo sensitive cancers like lymphoma, germ cell tumours or small cell lung cancer • SVC Stent–can be useful in cases of thrombosis and for patients not responding to cancer treatment
    • Removal of central venous device.

    Note: It is advisable to avoid placement of intravenous lines in the arms so that fluid is not injected into the already compressed SVC.
  • Non-pharmacological

    Treatment of SVC syndrome is divided into supportive and definitive therapy


Updated on,

5 Novemba 2020 12:49:41



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