Uperior vena cava syndrome (svcs) was first described in l757 in a patient with a syphilitic

42 

Hospital Physician January 1999

G r o u n d b r e a k e r s

Superior Vena Cava Syndrome

Shabir Bhimji, MD, PhD

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syphilis, and pyogenic infections. In addition, the

increased current use of invasive monitoring devices,

such as central lines, cardiac pacemakers, catheters for

total parenteral nutrition, and Swan-Ganz monitoring

devices, is associated with increasing reports of throm-

bosis of the superior vena cava. Finally, aneurysms of

the aorta and aortic branches are occasionally responsi-

ble for causing SVCS.

2 – 9

CLINICAL PRESENTATION

The typical symptoms of SVCS are most obvious

when obstructive disease is almost complete. Patients

with SVCS most often present with complaints of facial

edema and erythema, swelling of the neck and/or

arms, and visible dilatation of the veins in the upper

extremity. Patients with SVCS may also complain of dys-

pnea, persistent cough, and orthopnea. As the disease

progresses, the symptoms may include hoarseness, peri-

orbital edema, dysphagia, headaches, dizziness, syn-

cope, lethargy, and chest pain. Other findings may

include confusion and laryngeal and/or glossal edema. 

In some cases, the nerves that cross the superior

mediastinum (ie, vagus and phrenic nerves) are affect-

ed by SVCS. This nerve involvement can lead to

hoarseness and paralysis of the diaphragm. These

symptoms may be worsened by positional changes such

as bending forward, stooping, or lying down. Patients

with SVCS and vagus or phrenic nerve involvement

find significant symptom relief when they are in an

upright position, and many of these patients sleep in a

chair to avoid dyspnea.

The venous hypertension associated with SVCS can

sometimes produce cerebral vessel thrombosis and

hemorrhage with dire results. Of all the symptoms of

SVCS, the most life-threatening complications are cere-

bral or laryngeal edema.

2 –10

DIAGNOSIS

The diagnosis of SVCS can be made simply on physi-

cal examination. In cases in which the extent of disease

B h i m j i   :   S u p e r i o r   V e n a   C a v a   S y n d r o m e   :   p p .   4 2 – 4 6 ,   6 3