II. Pathophysiology

  1. Superior Vena Cava Obstruction to flow
    1. Mediastinal mass compressing superior vena cava
    2. Vena cava thrombosis
  2. Azygous vein may provide some collateral drainage

III. Causes

  1. Malignancy
    1. Bronchogenic Carcinoma (80%)
    2. Malignant Lymphoma (15%)
    3. Metastatic Disease
      1. Breast adenocarcinoma
      2. Testicular seminoma
  2. Benign Disease (Rare)
    1. Mediastinal fibrosis
      1. Idiopathic
      2. Histoplasmosis
      3. Actinomycosis
      4. Tuberculosis
    2. Vena Cava thrombosis
      1. Idiopathic
      2. Behcet's Syndrome
      3. Polycythemia Vera
      4. Paroxysmal Nocturnal Hemoglobinuria
      5. Long-term venous catheters, shunts or Pacemakers
    3. Benign Mediastinal tumor
      1. Aortic aneurysm
      2. Dermoid tumor
      3. Goiter
      4. Sarcoidosis

IV. Symptoms

  1. Dyspnea (50%)
  2. Neck and facial swelling (40%)
  3. Swelling of trunk and upper extremities (40%)
  4. Choking sensation
  5. Head fullness or pressure sensation
  6. Headache
  7. Chest Pain
  8. Cough
  9. Lacrimation
  10. Dysphagia

V. Signs

  1. Thoracic vein distention (65%)
  2. Neck vein distention (55%)
  3. Facial edema (55%)
  4. Tachypnea (40%)
  5. Plethora of the face and Cyanosis (15%)
  6. Edema of upper extremities (10%)
  7. Paralysis of Vocal Cords (3%)
  8. Horner's Syndrome (3%)
  9. Distended antecubital veins

VI. Associated Conditions

  1. Spinal Cord compression

VII. Radiology

  1. Chest XRay shows mass in 90%
    1. Right superior mediastinum (75%)
    2. Hilar Adenopathy (50%)
    3. Right Pleural Effusion (25%)
  2. Chest CT

VIII. Management

  1. Identify mass etiology
  2. Supportive care
    1. ABC Management
    2. Corticosteroids
    3. Diuretics
    4. Elevate the head of the bed
  3. Reduction in mass size
    1. Radiation Therapy
    2. Chemotherapy
    3. Surgical decompression
  4. Consider Anticoagulation
  5. Intravenous stenting

IX. Prognosis

  1. Poor prognostic sign: Predicts 90% mortality in 3 years

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