Question

60 year-old male presents with 6 months of weight loss,epistaxis, and increased headache when bending over. What's the diagnosis?

Answer

SVC Syndrome

• SVC syndrome is caused by compression or obstruction of the superior vena cava blocking anterograde flow.
• Most cases are secondary to extrinsic compression by malignancy. Other causes are secondary to internal obstruction (e.g., thrombosis).
• Symptoms present sub-acutely, worsen with bending over, and are secondary to increased venous pressure in the head and neck (e.g., epistaxis, headache, tinnitus, conjunctival injection, neck swelling, etc.).
• Treatment focuses on reversing the underlying cause (e.g., radiation or chemotherapy if due a sensitive tumor) and symptomatic treatment:
  • Steroids, diuretics, and hyperosmolar agents to reduce edema
  • Head of bed elevation to reduce brain edema
  • Anti-emetics to prevent vomiting-associated increases in intracranial pressure

Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). Jan 2006;85(1):37-42.

Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. Mar 2007;25(1):2-5

References

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