SVC Syndrome

Today in noon report we talked about a patient with an anterior superior mediastinal mass. 

The differential for these can be remembered as the five Ts:

- thyroid mass

- thoracic aorta

- teratoma

- thymoma

- terrible lymphoma

Sometimes these masses can compress the Superior Vena Cava, causing SVC Syndrome. 

Clinical Features of SVC Syndrome:

- Facial and neck edema, plethora 

- Venous collaterals visible over chest

- Stridor, hoarseness, cough (edema causing pressure on larynx)

- Dysphagia (edema causing pressure on pharynx)

- Cerebral edema: headaches, confusion

Causes of SVC Syndrome: The first step is to distinguish thrombosis from extrinsic compression by a mass. This is usually done with a contrast CT scan. Thrombosis is usually a result of instrumentation (catheters, pacemaker wires) while compression is usually from malignancy (lung, lymphoma or metastatic).

Treatment of SVC Syndrome:

- glucocorticoids

- radiation- when a tissue diagnosis has been made

- chemotherapy in non-Hodgkin's lymphoma and small cell lung cancer

- stenting by interventional radiology

- removal of hardware and/or local thrombolysis for acute thrombosis followed by anticoagulation (not indicated if chronic)

Check out this review of SVC syndrome from NEJM