Superior Vena Cava Syndrome

Bronwyn R. Stall and Brent A. Tinnel

 Background

What vessels form the SVC?

The right and left brachiocephalic veins join to form the SVC.

What vessels form the brachiocephalic vein?

The internal jugular and subclavian veins join to form the brachiocephalic vein.

What is SVC syndrome?

SVC syndrome is extrinsic or intrinsic obstruction of blood flow through the SVC leading to proximal congestion.

At what bony landmark does the SVC begin?

The SVC begins at the level of the sternal angle.

Describe the course of the SVC.

The SVC begins at the sternal angle, extends inferiorly along the right lat side of the ascending aorta, and inserts into the right atrium.

What predisposes the SVC to compression?

The SVC is a thin-walled vessel with relatively low intravascular pressure and is therefore susceptible to compression by surrounding rigid structures including enlarged LNs and the trachea, sternum, pulmonary artery, and right mainstem bronchus.

What vessels form the collateral system of the SVC?

The collateral system of SVC is formed by the azygous, mammary, vertebral, lat thoracic, paraspinous, and esophageal vessels.

What vessels join to form the azygous vein?

The right subcostal and right ascending lumbar veins coalesce to form the azygous vein.

What is the most common cause of SVC syndrome?

Malignancy is the most common cause of SVC −syndrome.

Name 4 benign causes of SVC syndrome.

Benign causes of SVC syndrome:

1. 
   

   Catheter-induced thrombosis

   
   
2. 
   

   Chronic mediastinitis

   
   
3. 
   

   Retrosternal goiter

   
   
4. 
   

   CHF

Name 6 cancers associated with SVC syndrome.

Cancers associated with SVC syndrome:

1. 
   

   Non–small cell lung cancer (NSCLC)

   
   
2. 
   

   Small cell lung cancer (SCLC)

   
   
3. 
   

   Non-Hodgkin lymphoma (NHL)

   
   
4. 
   

   Thymoma

   
   
5. 
   

   Primary mediastinal germ cell tumors

   
   
6. 
   

   Mesothelioma

What is the most common malignant cause of SVC syndrome?

The most common malignant cause of SVC syndrome is NSCLC.

Are NSCLC or SCLC pts more likely to develop SVC syndrome?

SCLC pts are more likely to develop SVC syndrome than NSCLC pts b/c of their propensity toward rapid growth in central airways.

What is the most common cause of SVC syndrome in pts <50 yo?

In pts <50 yo, the most common cause of SVC syndrome is lymphoma.

Which types of NHL are associated with SVC syndrome?

NHL types associated with SVC syndrome:

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