Superior vena cava obstruction
[End]
Approach
- Inspection
- Tortuous dilated veins overlying chest wall and neck
- Face may be plethoric and swollen
- Comment if patient is dyspnoeic at rest
Completion
- Examine further to find cause for obstruction
- Stigmata of lung carcinoma -nicotine stains, clubbing, horner's syndrome, lymphadenopathy
- Examine chest
Causes of SVC obstruction
- Within SVC
- Thrombosis (eg from CVP lines) - [treated by thrombolysis, angioplasty and stenting]
- Outside SVC
- Carcinoma of lung
- Lymphoma
- Carcinoma of thyroid
- Aortic aneurysm
- Mediastinal goitre
- Mediastinal fibrosis
- Constrictive pericarditis
Determining extent of obstruction
- IV injection of contrast into the veins in the arm can illustrate degree of obstruction
- CT thorax: may demonstrate
Oye Como Va!
Inferior venae cava obstruction
- Dilated veins observed across trunk
- Commonest cause = intra-abdominal malignancy
Caput Medusae
- Dilated veins around a porto-systemic anastmosis in the umbilical veins
Dilated abdominal veins can be distinguished with Harvey's test: - determines direction of flow
SVC obstruction: direction of flow above umbilicus downwards
IVC obstruction: direction of flow below umbilicus upwards
Caput medusae: direction of flow away from umbilicus
