SUPERIOR VENA CAVA (SVC) OBSTRUCTION

This is one of the few emergencies in terminal care. It is due to pressure from involved nodes in the superior mediastinum (usually the right paratracheal chain) and is seen most commonly in carcinomas of the bronchus (especially on the right) and breast, and in lymphoma.

The SVC drains blood from the head and upper body.

The full neck veins can be mis-diagnosed as heart failure (but are non-pulsatile).

The important early features are:

• Headaches (worse on bending)

• Blackouts

• Pink eyes

• Infra-orbital swellings (especially in the morning)

• Cyanosis and edema of the arms

• Thickening of neck (“tight collar”)

• Dilated veins (arms, neck, upper chest)

The enlarged nodes may also compress other structures in the superior mediastinum, including:

• Trachea (stridor, dyspnea)

• Esophagus (dysphagia)

• Recurrent laryngeal nerve (hoarseness)

Urgent radiotherapy is the treatment of choice, together with high dose steroids (dexamethasone 8mg per day). Chemotherapy (in lymphoma or small (oat) cell carcinoma of the bronchus) is occasionally indicated.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.