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%)
• Other cancers (10%)
Signs and Symptoms
Common symptoms and physical findings of SVCS are:
• oedema and change in colour in the areas drained by SVC(examples–face and upper limb)
• venous distension of neck, upper chest and arms
• 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
- 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.
• 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.
- Treatment of SVC syndrome is divided into supportive and definitive therapy
5 Novemba 2020 12:49:41