Superior Vena Cava Occlusive Disease

Superior vena cava (SVC) syndrome is a clinical entity with varied presentation and severity caused by obstruction of the central veins and superior vena cava. This can result from either malignant or benign etiologies. Benign etiologies include catheters or pacemakers, mediastinal fibrosis, hypercoagulability, and postsurgical or postradiation changes. Although historically malignant SVC obstruction has been much more common, there has been an increase in prevalence of benign SVC obstruction associated with the increasing use of intravenous devices. The symptoms and severity of SVC syndrome vary with the onset and severity of obstruction. In patients with slow progressive onset of obstruction, collateral circulation can develop to varied degrees over the chest wall and periscapular region, which may decrease the severity of patient symptoms. However, acute SVC syndrome is considered a medical emergency and can be life-threatening. Clinical symptoms include headache exacerbated by changes in position, disturbances in consciousness, facial and neck edema, pain in the face and neck, blurred vision, retroorbital pressure, hoarseness, and orthopnea.