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Oncology

Superior Vena Cava Syndrome

Obstruction of blood flow through the SVC, most commonly from malignant mediastinal disease (lung cancer, lymphoma) or catheter-related thrombosis, causing facial oedema and dyspnoea.

Last reviewed 22 May 2026 - MedicoMedics editorial team

Superior vena cava syndrome facial oedema and distended veins

Pathophysiology

External compression (right-sided lung tumours, mediastinal lymphoma, thymoma) or intraluminal thrombosis (central venous catheters, pacemaker leads) obstruct SVC flow. Collateral flow through azygos and internal mammary systems partially decompresses.

Sources: NCCN Palliative Care - SVC Syndrome (v2.2024); Wilson NEJM 2007;356:1862; ACR Appropriateness Criteria SVC

Clinical presentation

Facial swelling and plethora, distended jugular and chest wall veins, arm swelling, dyspnoea, cough, dysphagia, headache and visual disturbance. Pemberton sign: facial cyanosis on raising arms.

Grading (Yu classification)

Grade 0 asymptomatic to Grade 4 life-threatening (cerebral oedema, laryngeal oedema, cardiovascular collapse) - drives urgency.

Diagnosis

Contrast-enhanced CT chest with venous phase identifies level and cause; MRV if contrast contraindicated. Tissue diagnosis before empiric therapy in stable patients - crucial for lymphoma/germ cell where chemo is definitive.

Management

Elevate head of bed, supplemental oxygen. Grade 3-4: endovascular stent for rapid relief (relief within 24-72 h) followed by treatment of underlying malignancy. Systemic anticoagulation for catheter-related thrombosis, remove catheter when possible. Chemotherapy for SCLC/lymphoma; radiotherapy for NSCLC and radiosensitive tumours; steroids reserved for lymphoma or symptomatic tracheal oedema.

Sample USMLE-style MCQs

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Question 1

A 62-year-old smoker has facial swelling, distended chest wall veins and dyspnoea. CT shows a right upper lobe mass compressing the SVC. Immediate management if he has stridor and altered mentation?

Question 2

Which malignancy most commonly causes SVC syndrome?

Question 3

SVC syndrome due to a central venous catheter is best treated with:

Question 4

Which sign appears when a patient with mediastinal mass raises the arms above the head?

Question 5

Steroids are most appropriate in SVC syndrome caused by:

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 22 May 2026 by MedicoMedics editorial team.

  1. NCCN Palliative Care - SVC Syndrome (v2.2024)
  2. Wilson NEJM 2007;356:1862
  3. ACR Appropriateness Criteria SVC

Frequently asked

Is SVC syndrome always a medical emergency?

Only Grade 3-4 (cerebral oedema, laryngeal oedema, haemodynamic instability). Others allow time for tissue diagnosis.

Why prefer stenting?

Endovascular stents relieve symptoms within 24-72 h vs weeks with radiation; adjuncts thrombolysis for thrombus.

Which malignancies are most common causes?

Non-small cell lung cancer (~50%), small cell lung cancer (~25%), non-Hodgkin lymphoma (~10%).

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