Superior vena cava (SVC) syndrome is characterized by facial plethora, upper body venous engorgement, chest pain, soft tissue swelling, dyspnea, and even neurologic changes. Anything that impairs SVC drainage by intrinsic obstruction (thrombosis, anatomic narrowing) or extrinsic compression (mediastinal masses, non-small cell lung cancer, non-Hodgkin’s lymphoma, etc.) can result in this syndrome. Remember, venous structures like the SVC are fairly easy to compress!
Confirmatory diagnosis of SVC syndrome requires clinical suspicion and imaging (venography); however, transesophageal echocardiography (TEE) can be helpful as well! In the video clip, the top video illustrates a near total obstruction of the SVC. After alleviating external compression, the lower videos show good caval blood flow visualized with color-flow doppler. Even see the PA catheter (PAC) has room to wiggle around now!
In general, treating SVC syndrome depends on the etiology. Sometimes this requires securing the airway, tumor-directed therapy, anticoagulation, and judicious volume management.
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