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

Fri, 10/20/2017 - 8:01pm

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 

 

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