Superior Vena Cava Syndrome Case File

https://medical-phd.blogspot.com/2021/03/superior-vena-cava-syndrome-case-file.html

Author: Eugene C. Toy, MD, Lawrence M. Ross, MD, PhD, Han Zhang, MD, Cristo
Papasakelariou, MD, FACOG

CASE 11
A 48-year-old man complains of swelling of the neck and shortness of breath of 1-week duration.
He has noticed some nasal stuffiness with hoarseness of his voice for about 3 weeks and had
attributed these symptoms to an upper respiratory infection. He denies the use of alcohol but has
smoked two packs of cigarettes per day for 30 years. Lately, he feels as though something is
pushing against his throat. On physical examination, the patient’s face appears ruddy and
swollen. The jugular veins are distended.

⯈ What is the most likely diagnosis?

⯈ What is the most likely cause?
⯈ What are the anatomical structures involved?

ANSWER TO CASE 11:

Superior Vena Cava Syndrome

Summary: A 48-year-old heavy smoker has a 1-week history of neck swelling, dyspnea, and the
sensation of something pushing on his throat. Three weeks ago, he developed nasal stuffiness
and voice hoarseness. He has facial plethora, edema, and jugular venous distention.
• Most likely diagnosis: Superior vena cava (SVC) syndrome
• Most likely cause: Bronchogenic lung cancer
• Anatomical structures likely involved: SVC, trachea, and right mainstem bronchus

CLINICAL CORRELATION
The SVC receives venous drainage from the head, neck, upper limb, and thorax. Located in the
upper mediastinum, this thin-walled vessel is susceptible to pressure from external sources. The
most common cause of such external compression is malignancy, usually from a right-side
bronchogenic carcinoma. Such tumors can also compress the trachea, producing dyspnea, and
may involve the recurrent laryngeal nerve, producing hoarseness, as in this patient. The stellate
sympathetic ganglion may be compressed, leading to Horner syndrome, the clinical triad of
unilateral miosis (constricted pupil), facial anhydrosis (dryness), and ptosis (drooping eyelid).
The development of SVC syndrome is often an emergency because the trachea may be
obstructed, leading to respiratory compromise. The priority in treatment is directed toward the
airway, with oxygen and possibly diuretic agents, and corticosteroid agents to relieve the edema.
A chest radiograph, computed tomographic (CT) scan, and a tissue biopsy, in that order, would
be the next diagnostic steps. Most patients who have lung cancer are treated with radiotherapy.
Although patients who have SVC syndrome often respond well to the radiation treatment, the
overall prognosis is nearly always poor due to the advanced extent of the cancer.
APPROACH TO:
The Mediastinum

OBJECTIVES
1. Be able to describe the divisions of the mediastinum and the contents of each
2. Be able to describe the lymphatic drainage of the thoracic organs

DEFINITIONS 
Superior vena cava syndrome: Engorgement of the vessels of the head, neck, and upper limbs
accompanied by cough and respiratory difficulty due to compression of the SVC or its main
tributaries by a benign or malignant mass.
Bronchogenic carcinoma: A malignant tumor arising from the mucosal epithelium of the large
bronchi.
Mediastinum: The central region of the thorax between the two pleural cavities.