SVC obstruction

  • Definition
    • SVC obstruction is a narrowing or blockage of the superior vena cava, which is 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
    • Superior vena cava (SVC) obstruction is a relatively rare condition.

      It is most often 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
      • Metastatic lung cancer (lung cancer that spreads)
      • Testicular cancer
      • Thyroid cancer
      • Thymus tumor

      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:

      • Aortic aneurysm (a widening of the artery that leaves the heart)
      • Blood clots in the superior vena cava
      • Constrictive pericarditis (tightening of the thin lining of the heart)
      • Effects of radiation therapy for certain medical conditions
      • Enlargement of the thyroid gland (goiter)

      Catheters placed in the large veins of the upper arm and neck may cause blood clots in the superior vena cava.

  • 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:

      • Swelling around the eye
      • Swelling of the face
      • Swelling of the whites of the eyes

      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 include:

      • 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
  • Exams and Tests
  • Treatment
    • The goal of treatment is to relieve the blockage.

      Diuretics (water pills) or steroids may be used to temporarily 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.

  • Outlook (Prognosis)
    • The outcome varies, depending on the cause and the amount of blockage.

      SVC syndrome caused by a tumor is a sign that the tumor has spread, and it indicates a poorer long-term outlook.

  • Possible 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.

  • When to Contact a Medical Professional
    • Call your health care provider if you develop symptoms of SVC obstruction. Complications are serious and can sometimes be fatal.

  • 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. PMID: 16523051

      Ugras-Rey SS. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 123.

      Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-9. PMID: 17476012