Overview
The Superior Vena Cava is a large vein located in the upper chest, which collects blood from the head and arms and delivers it back to the right atrium of the heart. If this vein is compressed by outside structures, or if a thrombus or clot develops within it, then return blood flow to the heart is impeded. When blood flow to the heart is restricted, the increased pressure in the veins of the face and arms causes edema (fluid buildup) in these areas. This condition is referred to as superior vena cava syndrome.
Because the superior vena cava, like all veins, has a thin wall (there are no muscles in the walls of a vein as compared to the walls of an artery), and because there is little pressure inside the vein, it can be easily compressed by outside structures. The superior vena cava lies next to the upper lobe of the right lung and within the mediastinum [the space that contains the central structures of the chest: the heart, the trachea, the esophagus and the great vessels (aorta, vena cava)]. Abnormalities within any of these structures can cause the compression.
Less Common Symptoms Include:
- Dilation of veins on the skin surface as the body tries to establish new circulatory pathways to bypass the blockage, and a blue tinge to the skin (because the backed up blood doesn't have enough oxygen content)
- Cough,
- Shortness of breath,
- chest pain, and
- hoarseness.
How is Superior Vena Cava Syndrome Diagnosed ?
- A plain chest x-ray may show abnormal enlargement of the mediastinum or may reveal a tumor in the lung.
- Ultrasound may be used to look for blood clots in the arm leading into the chest.
- Computerized tomography (CT) scanning of the chest is most often used to diagnose superior vena cava syndrome. While it will show the blockage and may show a tumor, it will not necessarily diagnose the type of tumor.
- If a tumor is the cause of the obstruction, often a surgical procedure will be required to obtain a biopsy (a small piece of tissue), to help make the specific diagnosis as to the type of tumor.
How is Superior Vena Cava Syndrome Treated ?
Rarely does superior vena cava syndrome constitute a medical emergency. The ABCs of care are always a priority, insuring that the
Airway is well maintained,
Breathing is adequate and the Circulation (blood pressure and heart rate) is stable. The patient may feel more comfortable in an upright position. Furosemide (Lasix) is a diuretic that will decrease the volume of fluid within the bloodstream. With less pressure pushing against the obstructed superior vena cava, symptoms may be temporarily relieved.
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