What Is Superior Vena Cava Syndrome?

Superior vena cava syndrome (SVCS) is a group of symptoms caused by the partial or complete obstruction of blood flow returning to the right atrium through the superior vena cava, which is a common emergency for tumors. The patient developed acute or subacute dyspnea and swelling of the face and neck. Examination revealed facial, neck, upper limb and chest congestion, edema, which in turn developed into hypoxia and increased intracranial pressure, requiring urgent treatment.

Basic Information

nickname

Superior vena cava obstruction syndrome

English name

superior vena cava syndrome

Visiting department

Vascular surgery

Common causes

Primary or metastatic tumor of the mediastinum, inflammation, or embolism of the superior vena cava blood vessel itself

Common symptoms

Severe headache, dizziness, bloating, lethargy and belching

Causes of superior vena cava syndrome

1. Malignant tumor invades or compresses the superior vena cava.

2. Oppression of non-malignant diseases

Such as retrosternal thyroid tumors, thymomas, bronchial cysts, etc., or chronic fibrous neck tissue inflammation leading to compression of the tissues around the superior vena cava, such as idiopathic sclerosing mediastinitis, mediastinal fibrosis, etc.

3. Superior vena cava thrombosis

Thrombosis can be caused by congenital heart disease and after surgery, central venous intubation or pacemaker placement.

Clinical manifestations of superior vena cava syndrome

Venous reflux disorder

Head and neck and upper extremity edema, no obvious indentation of finger pressure, with cyanosis of the skin and lips, aggravated when lying flat, can be relieved after the upper body is upright, often accompanied by dizziness, bloating, and conjunctival congestion. Sometimes visible jugular-thoracic veins dilated, varicose veins of the chest and abdominal wall, and so on.

2. Symptoms of oppression

Compression of surrounding organs and nerves such as tumors may cause cough, dyspnea, poor eating, hoarseness, drooping eyelids, shrinking pupils, and no sweat on the face.

3. Impaired nerve function

Symptoms such as nausea and jet vomiting due to increased intracranial pressure may occur.

Superior vena cava syndrome

1. X-ray inspection

X-ray and plain film can be found in the upper mediastinum, right upper lobe, and superior vena cava around the space, there may be compression of the superior vena cava mass.

2. Doppler ultrasound

Understand the patency of the superior vena cava, the extent of thrombus, and whether there are other vascular lesions and external pressure lesions at the same time.

3.CT and magnetic resonance

The specific site of the superior vena cava obstruction and the collateral circulation can be displayed, which can clearly show the internal chest structure and the cause.

4. Superior vena cava angiography

Puncture and placement of the elbow vein or femoral vein on both sides can show the site of obstruction, as well as the situation of the distal and proximal ends, but there are many complications, so use with caution.

Diagnosis of superior vena cava syndrome

According to the patient's symptoms, signs and related imaging examinations, the diagnosis can be confirmed and the etiology is very important.

Superior vena cava syndrome treatment

The first priority is to relieve symptoms and then consider addressing the cause.

General processing

The patient should lie in bed, take a low head and feet, and give oxygen to reduce facial and upper body edema. Oxygen can relieve temporary dyspnea. Limiting sodium and fluid intake can reduce edema. The use of diuretics can reduce upper edema caused by obstruction and relieve symptoms. Intravenous fasting or 20% mannitol can be used. The effect is not good. It can be used in combination with dihydrogram urine plug and spironolactone. Pay attention to maintaining the volume to prevent blood concentration. Proper sedation and pain relief can help reduce anxiety and discomfort. For severe dyspnea and increased intracranial pressure, the application of dexamethasone and prednisone can inhibit the inflammatory response and reduce the pressure. After the symptoms are controlled, the primary tumor can be treated with radiotherapy and chemotherapy, and peripheral inflammation and connective tissue disease can be treated with immunosuppressive agents.

2. Anticoagulation therapy

It is suitable for the situation of thrombosis caused by non-malignant etiology, or used for radiation therapy and chemotherapy with malignant etiology. Anticoagulation and antithrombotic therapy given on a symptomatic basis can help relieve symptoms. For the superior vena cava obstruction caused by venous catheters, anticoagulation alone can eliminate the obstruction.

3. Surgical treatment

For benign lesions leading to superior vena cava syndrome and rapid deterioration of symptoms, resection of the mass, superior vena cava release, superior vena cava plasty, etc. can be used to improve superior vena cava obstruction. For malignant tumor invasion or compression, severe symptoms and no distant metastasis, life expectancy is prolonged after resection, consider resection of the primary tumor with the superior vena cava, and autologous vascular patches based on the extent of the superior vena cava defect. Artificial vascular repair, bypass bypass is required when the defect is large. For those with a large range of malignant tumor invasion, distant metastasis, and short expected survival time, palliative treatments such as intravenous stent implantation or bypass blood vessels can be given to solve the increased intracranial pressure, face and neck bloating, and dyspnea caused by patient obstruction Wait.