Under Pressure: SVC Syndrome

Thanks to Dr. Chris Fine who presented a fascinating case of SVC syndrome presenting with facial swelling, dyspnea, and myosis. Some take aways from his presentation:

  • SVC syndrome can result from internal or external compression of the SVC
  • Common etiologies include:

1) Malignancy

2) NSCLC (~50%), SCLC (~25%), NHL (~10%)

3) Nonmalignant

4) Thrombosis (esp. w/ indwelling device), fibrosing mediastinitis (fungal infxn), post-radiation fibrosis

  • Clinical Manifestations include facial swelling (or “head fullness”), arm swelling, cough, chest pain, dysphagia
  • Exam may reveal facial edema, distended veins (neck and chest wall). Arm edema, cyanosis, and plethora are less frequent.

  • Clinical consideration: Emergent or no?

 Courtesy UpToDate

Courtesy UpToDate

 The rarely seen "Pemberton's Sign" denoting facial swelling and flushing with raised arms in the setting of SVC syndrome. Courtesy Annals of Internal Medicine. 

The rarely seen "Pemberton's Sign" denoting facial swelling and flushing with raised arms in the setting of SVC syndrome. Courtesy Annals of Internal Medicine.