Alternate Names: Superior vena cava obstruction; Superior vena cava syndrome

Causes and Risks:

Superior vena cava (SVC) obstruction is a relatively rare condition. It usually is caused by cancerous or inflammatory conditions of the mediastinum (the area of the chest under the breastbone and between the lungs).

Other causes include lymphomas, mediastinal tumors, cancer of the lung with extension into the mediastinum, and chronic fibrosis (scarring). Causes also include inflammatory conditions such as tuberculosis, histoplasmosis infection, thrombophlebitis (particularly extension of thrombophlebitis of superficial veins or the subclavian vein), aortic aneurysm, and constrictive pericarditis.

Prevention: Prompt treatment of causative disorders may reduce the risk of development of SVC obstruction.

Symptoms:

• neck swelling, facial swelling, or arm swelling
• swelling around the eye socket (periorbital)
• reddish face or cheeks
• reddish palms
• reddish mucous membranes (inside the nose, mouth, and so on)
• redness changing to blueness later
• headache
• dizziness
• vision changes
• fainting
• decreased alertness

Signs and Tests:

An examination may show dilated cutaneous (skin) vein of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.

A bronchoscopy may be performed if lung cancer is suspected.

Obstruction of the SVC may show on:

• chest X-ray
• MRI of chest or CT scan of the chest
• coronary angiography
• Doppler ultrasound
• radionuclide ventriculography

This disease may also alter the results of the following tests:

• liver scan
• abdominal MRI

Treatment:

The goal of treatment is relief of the obstruction.

Diuretics may be used to relieve swelling.

The cause must be identified and treated. This may include radiation, chemotherapy, surgical removal of tumors, or other treatment. Surgery to bypass of the obstruction is rarely performed.

Prognosis: The outcome varies depending of the cause and the extent of obstruction.

Complications: The throat could swell and block the airways.

Call your health care provider if a lung tumor is present and symptoms indicate SVC obstruction may be present. Complications are serious and sometimes are fatal.