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Superior Vena Cava (SVC) Sydrome
-Mass in the chest causes compression of the SVC
-Patients usually complain of facial or arm swelling, redness (plethora), may have voice changes or cough
-May have distended neck veins on exam
-Chest x-ray and CT chest with contrast to define tumor
-Treatment is usually not emergent unless signs or symptoms of increased intracranial pressure, usually treated with chemo or radiation
Pulmonary Embolism and Malignant Pericardial Effusion
-Patients with cancer are at high risk for PE- any chest pain or shortness of breath is PE until proven otherwise
-Pericardial effusions- usually from breast or lung cancer or chemo side effect
-Can be very large as they can accumulate very slowly, giving the heart a chance to adapt
-Symptoms of heart failure- chest pain/SOB, dyspnea on exertion
-Exam- muffled heart sounds (rare), distended neck veins
-EKG- electrical alternans (varying R wave height from heart swinging in the effusion), low R wave voltage
-Chest x-ray- may show cardiomegaly
-Bedside ultrasound- for diagnosis and to determine if tamponade (RV collapse)
-Unstable patients- may need pericardiocentesis in the ED as a life saving procedure
-Stable patients- effusion can be drained in the OR or cath lab
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