Superior vena cava syndrome differential diagnosis

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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 shortness of breath 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), shortness of breath, and tachypnea.	In cardiac tamponade, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%.
Mediastinitis	Elevated venous pressure, tachypnea and shortness of breath.	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 (procalitonin).
Acute respiratory distress syndrome	Low blood pressure,hypotension, and shortness of breath.	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.