Chest X ray may be helpful in identifying the mass
CT scan of chest may identify the mass
Venography may help define the site of the obstruction and will be necessary if a stent is to be inserted.
Treatment of Superior Vena Caval Obstruction
Always consider admission to hospital to allow adequate investigation and treatment to improve symptom control and prevent the development of stridor.
Whilst waiting for a definitive management plan the patient should be started on 12mg oral dexamethasone as a single dose. If the patient is at risk of GI side effects start appropriate GI protection using a proton pump inhibitor. This should be continued until other interventions have been carried out, and then the steroids should be tailed off as dictated by the patient’s condition.
Discuss with local oncologist and/or specialist in palliative medicine about the use of an SVC stent inserted under radiological control and/or the role of oncological treatment to reduce the size of the tumour.
Manage symptoms particular headache and breathlessness. Both may warrant oral opioids.
