Superior Venecaval Syndrome

By Dr Deepu
Images
Definition
History
Pathophysiology
Presentation and Findings
Causes
Diagnostic Workup
Management

Diagnostic workup

Patients presenting with overt superior vena cava syndrome (SVCS) may be diagnosed by means of physical examination alone. However, subtle presentations necessitate diagnostic imaging.

Chest X Ray

Chest radiography may reveal a widened mediastinum or a mass in the right side of the chest. Only 16% of the patients studied by Parish et al in 1981 had normal findings on chest radiography.

CT Scan

Computed tomography (CT) has the advantage of providing more accurate information on the location of the obstruction and may guide attempts at biopsy by mediastinoscopy, bronchoscopy, or percutaneous fine-needle aspiration. It also provides information on other critical structures, such as the bronchi and the vocal cords.

A CT scan of the chest is the initial test of choice to determine whether an obstruction is due to external compression or due to thrombosis. The additional information is necessary because the involvement of these structures requires prompt action for relief of pressure.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) has not yet been sufficiently investigated in this setting, but it appears promising. It has several potential advantages over CT, in that it provides images in several planes of view, allows direct visualization of blood flow, and does not require iodinated contrast material (an especially important characteristic when stenting is anticipated).

MRI is an acceptable alternative for patients with renal failure or those with contrast allergies. Potential disadvantages include increased scanning time with attendant problems in patient compliance and increased cost.

venography

Invasive contrast venography is the most conclusive diagnostic tool (see the image below). It precisely defines the etiology of obstruction. It is especially important if surgical management is being considered for the obstructed vena cava.
Management