Pathophysiology

• Venous obstruction in the mediastinum and upper chest.
• Usual cause is tumour, particularly lymphoma.
• Pulmonary congestion leads to dyspnoea.
• Congestion of intracranial vessels leads to feeling of fullness and headache.

Signs and symptoms

• Headache, pressure or ‘fullness’ in head, worse on sneezing or bending forwards.
• Shortness of breath and discomfort in chest.
• Facial plethora, obvious collateral vessels over the upper chest wall.

Management

• Management of individual symptoms (particularly pain and dyspnoea).
• Reduction of tumour oedema using steroids (NB ONLY use in discussion with oncologists as some lymphomas may be very sensitive to steroids).
• Reduction of tumour mass using radiotherapy.
• Surgical insertion of stent into the SVC.