60 year old male with 6 months of weight loss and recent epistaxis. Diagnosis?
Answer: Partial obstruction of the Superior vena cava (SVC)
SVC Syndrome
SVC syndrome is caused by compression or obstruction of the superior vena cava blocking anterograde flow.
Most cases are secondary to extrinsic compression by malignancy. Other causes are secondary to thrombosis and internal obstruction (e.g., central venous catheter placement).
Symptoms present sub-acutely, worsen with bending over, and are secondary to increased venous pressure in the head and neck (e.g., epistaxis, headache, tinnitus, conjunctival injection, neck swelling, etc.).
Treatment focuses on reversing the underlying cause (e.g., radiation or chemotherapy if due a sensitive tumor) and treatment of symptoms:
Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). Jan 2006;85(1):37-42.
Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. Mar 2007;25(1):2-5; quiz 6.
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