Superior vena cava syndrome history and symptoms

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

Overview

The hallmark of superior vena cava syndrome is elevated jugular pressure and dyspnea. A positive history of cancer and intra-vascular devices are suggestive of superior vena cava syndrome. The most common symptoms of superior vena cava syndrome include upper body swelling, dyspnea, and cough.

History

Obtaining the history is the most important aspect of making a diagnosis of SVCS. It provides insight into cause, possible recurrence and associated comorbid conditions. Complete history will help determine the correct therapy and helps in determining the prognosis. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and drug usage have to be obtained. Specific areas of focus when obtaining the history, are outlined below:

• Onset, duration and progression of symptoms
• History of cancer
• History of infections
• Recent surgeries or interventions (eg. intravascular devices)
• Associated symptoms (lethargy, fever, confusion)
• Previous response to glucocorticoids

Symptoms

SVCS usually presents more gradually with an increase in symptoms over time as malignancies increase in size. Symptoms occur when obstruction of venous blood flow back to the heart is compromised. Symptoms may begin suddenly or gradually, and may worsen with posture change. Symptoms are quite varied among benign and malignant SVCS. They can be ranging from sub-clinical presentation to death. SVCS is a oncological emergency which if untreated never resolves on its own.

Common symptoms

The most common symptoms include the following:

• Dyspnea
• Cough
• Swelling of the face, neck, trunk, and arms

Less common symptoms

Less common symptoms include the following:

• Hoarseness
• Chest pain
• Problems swallowing and/or talking
• Coughing up blood
• Headache
• Lightheadedness
• Decreased alertness
• Dizziness
• Fainting
• Sensation of head or ear "fullness"
• Vision changes