This morning we presented a case of SVC syndrome with complete thrombotic occlusion.

SVC 101

• What is it?
  • Obstruction of blood flow through the SVC
• What are the three mechanisms by which this can happen?
  • Thrombosis
  • Invasion
  • Extrinsic Pressure
• How does the body compensate?
  • Collateral veins develop to return blood to the heart

Causes of SVC Syndrome

SVC Symptoms

• Facial and neck swelling
• Chest pain
• Respiratory symptoms
• Neurological manifestations such as head fullness, which may worsen by bending forward or lying own
• Headaches, confusion, audiovisual disturbances
• Cerebral edema can be fatal
• Arm swelling
• Onset of symptoms depends on whether collaterals had a chance to form

Physical Examination

• May see distended chest wall veins
• Pemberton’s sign may be positive
  • initially discovered in the context of a goiter, it can also be useful to identify other causes of SVC obstruction
  • have the patient raise their arms for two minutes and watch for increasing facial plethora (swelling and redness)

Treatment Options

• Depends on urgency. If emergent, ABCs then straight to endovascular management with pharmacologic thrombolysis/balloon angioplasty/etc +/- stenting
• If non-emergent, can obtain imaging and biopsy and plan treatment course with chemotherapy or radiation

Lastly, check out Radiopedia! It’s a great learning tool and really fun too.

https://radiopaedia.org/?lang=us