Question

60 year-old male presents with 6 months of weight loss,epistaxis, and increased headache when bending over. What's the diagnosis?

Answer

SVC Syndrome SVC syndrome is caused by compression or obstruction of the superior vena cava blocking anterograde flow.

Most cases are secondary to extrinsic compression by malignancy. Other causes are secondary to internal obstruction (e.g., thrombosis).

Symptoms present sub-acutely, worsen with bending over, and are secondary to increased venous pressure in the head and neck (e.g., epistaxis, headache, tinnitus, conjunctival injection, neck swelling, etc.).

Treatment focuses on reversing the underlying cause (e.g., radiation or chemotherapy if due a sensitive tumor) and symptomatic treatment: Steroids, diuretics, and hyperosmolar agents to reduce edema Head of bed elevation to reduce brain edema Anti-emetics to prevent vomiting-associated increases in intracranial pressure

Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). Jan 2006;85(1):37-42. Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. Mar 2007;25(1):2-5

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