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Last reviewed: 21 Apr 2025
Last updated: 18 Jul 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • localised oedema of the face and upper extremities
  • dyspnoea
  • facial plethora
  • cough
  • distended neck veins
  • distended chest veins
  • hoarseness of voice
  • lymphadenopathy
  • blurred vision
  • stridor
  • confusion/stupor

Other diagnostic factors

  • anorexia
  • weight loss
  • haemoptysis
  • headache
  • chest pain
  • mental changes
  • fever
  • skin rash
  • arthralgia
  • laryngeal oedema
  • cyanosis
  • papilloedema
  • coma

Risk factors

  • smoking
  • multiple pacemaker leads
  • central venous catheters/ports
  • age >50 years
  • radiation

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • chest CT
  • chest MRI
  • ultrasound of upper extremities

Investigations to consider

  • venography
  • biopsy
  • sputum cytology
  • thoracentesis
  • sputum culture
  • erythrocyte sedimentation rate
  • C-reactive protein

Treatment algorithm

Contributors

Authors

Kul Aggarwal, MD, MRCP, FACC
Kul Aggarwal

Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

KA declares that he has no competing interests.

Albert K. Chan, MD

Assistant Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

AKC declares that he has no competing interests.

Acknowledgements

Professor Kul Aggarwal and Dr Albert K Chan would like to gratefully acknowledge Dr Nipun Arora and Lokesh Tejwani, previous contributors to this topic. NA declares that he has no competing interests.

Peer reviewers

Debabrata Mukherjee, MD

Gill Foundation Professor of Interventional Cardiology

Director of Cardiac Catheterization Laboratories

Gill Heart Institute

Division of Cardiovascular Medicine

University of Kentucky

Lexington

KY

Disclosures

DM declares that he has no competing interests.

Syed Wamique Yusuf, MD, MRCPI, FACC

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Andrew Turley, MB ChB

Cardiology Specialist Registrar

The James Cook University Hospital

Middlesbrough

UK

Disclosures

AT declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Azizi AH, Shafi I, Shah N, et al. Superior vena cava syndrome. JACC Cardiovasc Interv. 2020 Dec 28;13(24):2896-2910.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: suspected upper-extremity deep vein thrombosis. 2019 [internet publication].Full text

Uberoi R. Quality assurance guidelines for superior vena cava stenting in malignant disease. Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):319-22. Abstract

​Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016 Feb;149(2):315-52.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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