Signs and Symptoms

• Face, neck, and upper extremity edema, dyspnea, cough, dilated upper extremity veins and, orthopnea are most common

• Less common—hoarseness, dysphagia, dizziness, headache, lethargy, chest pain

• Patients with elevated ICP may have mental status changes

• Patients with airway obstruction may have shortness of breath Diagnostic tests

• Tissue biopsy to determine underlying malignancy (if unknown), chest x-ray, CT scan, bronchoscopy, mediastinoscopy

Surgical options for the management of SVCS include stent placement and surgical bypass. SVC stenting may provide longer term relief of symptoms than radiotherapy, thus it is often used in the palliative care setting when chemotherapy has failed.36 One disadvantage of SVC stenting is the need for anticoagulation, especially in patients at high risk for thrombosis. The role of surgical bypass is limited to patients with complete SVC obstruction or patients who are refractory to chemotherapy and radiotherapy, thus it is rarely indicated.

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