From the Guidelines
Superior vena cava (SVC) thrombus presents with a constellation of findings collectively known as SVC syndrome, characterized by facial and neck swelling, prominent neck and chest wall veins, and upper extremity edema, as reported in the most recent study 1. The examination findings of SVC thrombus include:
- Facial and neck swelling
- Prominent neck and chest wall veins
- Upper extremity edema
- Facial plethora (redness)
- Periorbital edema
- Conjunctival suffusion
- Respiratory symptoms such as dyspnea, cough, and hoarseness
- Neurological findings including headache, visual disturbances, and altered mental status due to cerebral venous congestion These physical signs are typically more pronounced when the patient is in a recumbent position or performs Valsalva maneuvers, and dilated collateral veins may be visible across the chest wall as the body attempts to establish alternative venous return pathways, as described in 1. The severity of symptoms depends on how quickly the obstruction develops, as rapid onset allows less time for collateral circulation to develop, and complete assessment should include evaluation for underlying causes, as SVC thrombus is often secondary to malignancy, indwelling catheters, or hypercoagulable states, as noted in 1 and 1. It is essential to note that the diagnosis of SVC thrombus is typically made using a combination of ultrasound and venography imaging, as recommended in 1 and 1.
From the Research
Examination Findings of Superior Vena Cava Thrombus
The examination findings of superior vena cava thrombus can be identified through various methods, including:
- Clinical signs and symptoms such as plethora, cyanosis, dyspnea, stridor, cough, and hoarseness, as well as more serious complications such as cerebral edema leading to headache, confusion, and coma 2
- Imaging studies, including computed tomography and ultrasound, which can confirm the diagnosis of superior vena cava thrombus 2, 3
- Point-of-care ultrasound (POCUS) can also be used to rapidly and safely diagnose superior vena cava syndrome due to extensive thrombosis of the deep venous system cephalad to the SVC 3
- Venograms can be performed before and after thrombolytic therapy to assess the effectiveness of treatment 4
Diagnostic Criteria
The diagnostic criteria for superior vena cava thrombus include:
- Obstruction of blood flow through the SVC, leading to edema in the upper body, including the head, neck, and upper extremities 2
- Thrombosis of the SVC, which can be caused by various factors, including malignancy, spontaneous thrombus, infections, and iatrogenic etiologies 3
- Clinical suspicion, which usually leads to further imaging studies to confirm the diagnosis 3
Treatment Options
The treatment options for superior vena cava thrombus include:
- Thrombolytic therapy, which can be effective in relieving symptoms and preserving the catheter 5, 4
- Anticoagulation therapy, which can be used to prevent further thrombosis 2
- Catheter-directed thrombolysis, which can be used to treat symptomatic thrombosis of the SVC 5
- Endovascular techniques, such as angioplasty and stenting, which can be used to treat caval thromboses 6