Advertisement

Superior Vena Cava Obstruction

  • Belinda A. CampbellEmail author
  • John M. Troupis
  • Jonathan Langton
Reference work entry

Abstract

In the current era of increased availability and frequency of surveillance imaging for oncology patients, superior vena caval obstruction (SVCO) is often an incidental finding in asymptomatic patients. Less commonly, SVCO may present with advanced symptomatology, and in these cases the SVCO may represent rapid disease progression and/or the first presentation of malignancy. Contrast enhanced computed tomography (CT) is exceptionally useful for the diagnosis of SVCO, and often reveals extrinsic compression by mediastinal lymphadenopathy as the more common mechanism for malignant SVCO. Non-small cell and small cell lung cancers constitute the more common histologies, with metastatic mediastinal lymphadenopathy or direct mediastinal invasion causing the SVCO. Radiotherapy is the traditional treatment of choice for patients with SVCO. For patients with severe symptoms, treatment of SVCO constitutes a medical emergency and requires urgent treatment with endovascular stenting to restore patency and produce rapid relief of potentially life-threatening symptoms.

References

  1. Bae KT, et al. Contrast enhancement in cardiovascular MDCT: effect of body weight, height, body surface area, body mass index, and obesity. AJR Am J Roentgenol. 2008;190(3):777–84.CrossRefGoogle Scholar
  2. Dulce M, et al. Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography. Br J Anaesth. 2014;112(2):265–71.CrossRefGoogle Scholar
  3. Fagedet D, et al. Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol. 2013;36(1):140–9.CrossRefGoogle Scholar
  4. Ganeshan A, et al. Superior vena caval stenting for SVC obstruction: current status. Eur J Radiol. 2009;71(2):343–9.CrossRefGoogle Scholar
  5. Gosselin MV, Rubin GD. Altered intravascular contrast material flow dynamics: clues for refining thoracic CT diagnosis. AJR Am J Roentgenol. 1997;169(6):1597–603.CrossRefGoogle Scholar
  6. Gray H. Gray’s anatomy of the human body. Philadelphia: Lea & Febiger; 1918.Google Scholar
  7. Kaufman J, Lee M. Vascular and Interventional Radiology: The Requisites. Requisites series. 2nd ed. Philadelphia: Elsevier Saunders; 2014.Google Scholar
  8. Khouzam RN, Minderman D, D’Cruz IA. Echocardiography of the superior vena cava. Clin Cardiol. 2005;28(8):362–6.CrossRefGoogle Scholar
  9. Kim CY, Merkle EM. Time-resolved MR angiography of the central veins of the chest. AJR Am J Roentgenol. 2008;191(5):1581–8.CrossRefGoogle Scholar
  10. Kim H, et al. Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction. Korean J Radiol. 2003;4(3):146–52.CrossRefGoogle Scholar
  11. Lawler LP, Fishman EK. Pericardial varices: depiction on three-dimensional CT angiography. AJR Am J Roentgenol. 2001;177(1):202–4.CrossRefGoogle Scholar
  12. Lepper PM, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care. 2011;56(5):653–66.CrossRefGoogle Scholar
  13. Lin FY, et al. The right sided great vessels by cardiac multidetector computed tomography: normative reference values among healthy adults free of cardiopulmonary disease, hypertension, and obesity. Acad Radiol. 2009;16(8):981–7.CrossRefGoogle Scholar
  14. Massmann A, et al. A wire transposition technique for recanalization of chronic complex central venous occlusions. Phlebology. 2016;31(1):57–60.CrossRefGoogle Scholar
  15. Mauro M, et al. Image-guided interventions. Expert radiology series. 2nd ed. Philadelphia: Elsevier Saunders; 2014.Google Scholar
  16. Plekker D, et al. Clinical and radiological grading of superior vena cava obstruction. Respiration. 2008;76(1):69–75.CrossRefGoogle Scholar
  17. Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol (R Coll Radiol). 2002;14(5):338–51.CrossRefGoogle Scholar
  18. Straka C, et al. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. Spring. 2016;5:229.CrossRefGoogle Scholar
  19. Tomasian A, et al. Noncontrast 3D steady state free precession magnetic resonance angiography of the thoracic central veins using nonselective radiofrequency excitation over a large field of view: initial experience. Investig Radiol. 2008;43(5):306–13.CrossRefGoogle Scholar
  20. Tzifa A, et al. Endovascular treatment for superior vena cava occlusion or obstruction in a pediatric and young adult population: a 22-year experience. J Am Coll Cardiol. 2007;49(9):1003–9.CrossRefGoogle Scholar
  21. Yu JB, Wilson LD, Detterbeck FC. Superior vena cava syndrome–a proposed classification system and algorithm for management. J Thorac Oncol. 2008;3(8):811–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Belinda A. Campbell
    • 1
    Email author
  • John M. Troupis
    • 2
  • Jonathan Langton
    • 3
  1. 1.Department of Radiation Oncology and Cancer ImagingPeter MacCallum Cancer CentreMelbourneAustralia
  2. 2.Department of Diagnostic ImagingMonash HealthClaytonAustralia
  3. 3.Department of Interventional and Diagnostic ImagingMonash HealthClaytonAustralia

Personalised recommendations