History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include smoking history, multiple pacemaker leads, and central venous catheters.
localised oedema of the face and upper extremities
Present in 80% of cases.[9]
If oedema is localised to upper extremities and face, obstruction of the superior vena cava should be considered.
dyspnoea
Present in 60% of cases.[20]
Usually made worse by bending forwards or lying down (orthopnoea).
May suggest lung malignancy or chronic infection.
facial plethora
Due to venous engorgement and oedema.
cough
Present in 54% of cases.[10]
Can be related to underlying aetiology or laryngeal oedema.
distended neck veins
Seen in 63% of cases and due to increased venous pressure.[1]
Bending forwards usually worsens venous engorgement and is a helpful clinical sign.
distended chest veins
Seen in 53% of cases and due to increased venous pressure.[1]
Prominent collateral veins covering the anterior chest wall may be visible.
Bending forwards usually worsens venous engorgement and is a helpful clinical sign.
hoarseness of voice
Present in 17% of cases.[6]
Can be related to underlying aetiology or laryngeal oedema.
lymphadenopathy
Lymphoma is a possibility if lymphadenopathy is outside of the chest.
uncommon
Other diagnostic factors
common
anorexia
May suggest lung malignancy or chronic infection.
weight loss
May suggest lung malignancy or chronic infection.
haemoptysis
May suggest lung malignancy or chronic infection.
uncommon
headache
Present in 9% of cases.[6]
Due to increased cerebral venous pressure.
chest pain
Usually pleuritic; related to pleural involvement from malignancy, infection, or autoimmune diseases.
fever
May be indicative of collagen-vascular disease.
skin rash
May be indicative of collagen-vascular disease.
arthralgia
May be indicative of collagen-vascular disease.
Risk factors
strong
smoking
Strong relationship to lung cancer, the most common overall cause of superior vena cava syndrome.
multiple pacemaker leads
Becoming an increasingly frequent benign cause of superior vena cava syndrome.
central venous catheters/ports
Becoming an increasingly frequent benign cause of superior vena cava syndrome.[8]
weak
age >50 years
Lung malignancy should be considered as the most likely aetiology in patients >50 years of age.
radiation
Excess radiation to the mediastinum can lead to fibrosis causing superior vena cava obstruction.
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