What's the Diagnosis (Critical Care Edition) By. Dr. Kim Chavez

Patient presents with neck and facial swelling and is complaining of shortness of breath. CXR is here, what's the diagnosis? (scroll down for answer)














Answer: SVC Syndrome

SVC Syndrome

  • Most commonly caused by an obstructing malignancy (i.e. lung cancer)
  • Thrombosis is another common cause due to central venous catheters or pacemakers
  • The severity of symptoms will depend on the location and speed of obstruction especially if venous collaterals do not have time to develop (typically at the azygos or post-azygos vein, pre-azygos typically presents more insidiously) 
  • Symptoms include facial plethora, flushed face, distended neck veins, dyspnea, cough, hoarseness
  • If respiratory compromise is imminent due to extrinsic compression, patients may benefit from emergent stent placement and radiotherapy; thrombolysis and anticoagulation may be necessary if the cause is a thrombus