Superior vena cava obstruction

Definition

SVC obstruction is a narrowing or blockage of the superior vena cava -- 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

Causes

Superior vena cava (SVC) obstruction is a relatively rare condition.

Most often it is caused by cancer 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 lymphoma, cancer of the lung that spreads, breast cancer, testicular cancer, thyroid cancer, and thymic tumors.

Superior vena cava obstruction can also be caused by noncancerous conditions that cause chronic fibrosis (scarring). These conditions include lung infections (such as tuberculosis), histoplasmosis infection, and thrombophlebitis.

Other causes of superior vena cava obstruction include aortic aneurysm, constrictive pericarditis, and goiter.

Symptoms

• Neck swelling, facial swelling, or arm swelling
• Swelling around the eye socket (periorbital)
• Sensation of head or ear "fullness"
• 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

Exams and Tests

An examination may show enlarged veins 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
• CT scan of the chest or MRI of 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 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 extent of obstruction.

Possible Complications

The throat could swell and block the airways.

When to Contact a Medical Professional

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

Prevention

Prompt treatment of other medical disorders may reduce the risk of developing SVC obstruction.

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