see: [Hayes' Superior Vena Cava Obstruction](x-devonthink-item://C204FCB5-6B40-43D3-A805-7A9746736B28), [Dunn - other oncologic emergencies](x-devonthink-item://2CB10C13-DD29-4E8A-A9BF-560FC57E7AB8) [[Pancoast tumour]] sign of **SVC obstruction** > occurs as a result of thoracic inlet obstruction from a mass lesion which is elevated into the thoracic inlet on elevation of the arms **manoeuvre:** - lift arms over head and wait for 1 min - usually within 30 seconds after raising arms facial plethora develops (compression of jugular veins) - inspiratory stridor - non-pulsatile elevation of jugular venous pressure ![[Pasted image 20241102174145.png]] **causes** *neoplastic* - primary lung cancer (SCC or small cell, [[Pancoast tumour]] - lymphoma - metastatic breast Ca - metastatic testicular Ca *non-neoplastic* - SVC thrombus (eg IJ *CVC-associated* thrombosis) - aortic aneurysm - thyroid enlargement/ goitre - posterior mediastinal mass - radiotherapy - TB - syphilis # SVC obstruction - acute obstruction of the SVC causes SVC syndrome, which clinically presents as facial and upper extremity oedema and cyanosis - acute SVC syndrome is a *vascular emergency* - chronic occlusion or stenosis of SVC may be asymptomatic - facial oedema that improves with standing is characteristic **clinical features** - ↑ dyspnoea (a/w tracheal oedema) - sensation of drowning or choking, especially *supine* - [[Headache]] (due to cerebral oedema often worse when bending down) - voice hoarseness and cough due to tracheal irritation / compression - may have **stridor** - dysphagia - dizziness and [[Syncope]] → in severe cases venous return from the SVC is compromised - pemberton's sign ## management - elevate head of bed/ keep patient upright - avoid arms above head (eg for CT scan) - use lower limb for cannulation - supplemental O2 as needed - analgesia - [[Steroids|Dexamethasone]] if severe symptoms to reduce tumour mass by ↓ inflammatory oedema (16mg oral, s/c, or IV) - anticoagulation if thrombus - referral - Rtx - endovascular stent placement - chemo , etc