Superior vena cava syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Maria Fernanda Villarreal, M.D. [2]

Overview

Superior vena cava syndrome should be differentiated from other causes of dyspnea and jugular venous distention, such as, cardiac tamponade, chronic obstructive pulmonary disease, mediastinitis, pneumonia, acute respiratory distress syndrome, and syphilis.

Differentiating Superior Vena Cava Syndrome from other Diseases

The table below summarizes the findings that differentiate superior vena cava syndrome from other conditions that also cause dyspnea and jugular venous distention:

Differential Diagnosis	Similar Features	Differentiating Features
Cardiac tamponade	Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension	In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes
Chronic obstructive pulmonary disease	Elevated jugular venous pulse (JVP), dyspnea, and tachypnea	In COPD, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%
Mediastinitis	Elevated venous pressure, tachypnea and dyspnea	In mediastinitis, differentiating features include: fever, positive confirmation of organisms, and elevated leukocytes
Pneumonia	Hypotension, tachypnea, cough, and chest pain	In pneumonia, differentiating features include: bronchial breath sounds, leukocytosis with left shift, positive blood culture, and altered laboratory findings (eg. procalcitonin)
Acute respiratory distress syndrome	Low blood pressure, hypotension, and dyspnea	In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles, and pulmonary wedge pressure < 18 mmHg
Syphilis	Enlarged lymph nodes, hypotension, and dysphagia	In syphilis, differentiating features include: positive treponemal tests, history of unprotected sex, and superficial mucosal patches