Emergencies >> Superior vena cava syndrome (SVCS)
SCLC and NHL are the most frequent causes of SVCS. Because of the prognostic impact, the differentiation between lymphoma and carcinoma is critical.
Congestion and edema of the upper thorax, neck and head (swelling of face and neck, prominent veins on the thorax, and possibly thrombosis). Cerebral edema may be present!
Diagnosis and therapy:
- Administration of oxygen, upright position, consider diuretics
- Physical examination
- CT of thorax and abdomen
- Biopsy and histology before administration of cortisone, which may hinder the diagnosis of NHL!
- Tumor markers may help distinguish between NHL and carcinoma (CEA, CYFRA, NSE, and beta-HCG and AFP in young patients).
- Steroids (e. g. dexamethasone 40 mg / day)
- Anticoagulation (if no bleeding is present, no thrombocytopenia or coagulation disorders) to prevent thrombosis
- Consider stenting of vena cava
- Specific treatment of underlying condition (chemotherapy / emergency radiotherapy)
It is important to make a diagnosis, i. e. to get a biopsy sample and a histology. Look for easily accessible tumors in enlarged peripheral lymph nodes, lung nodules, etc. In case of a single mediastinal tumor, a more invasive procedure has to be chosen. A CT-guided biopsy has a sensitivity of 70%, while mediastinoscopy has a sensitivity of 98%. According to newer publications, mediastinoscopy is not associated with an increased mortality in SVCS and should be considered in clinical emergencies.