Last reviewed:October 2019
Last updated:July  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • localised oedema of the face and upper extremities
  • dyspnoea
  • facial plethora
  • cough
  • distended neck veins
  • distended chest veins
  • hoarseness of voice
  • lymphadenopathy
  • blurred vision
  • stridor
  • confusion/stupor

Other diagnostic factors

  • anorexia
  • weight loss
  • haemoptysis
  • headache
  • chest pain
  • mental changes
  • fever
  • skin rash
  • arthralgia
  • laryngeal oedema
  • cyanosis
  • papilloedema
  • coma

Risk factors

  • smoking
  • multiple pacemaker leads
  • central venous catheters/ports
  • age >50 years
  • radiation

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • chest CT
  • chest MRI
  • ultrasound of upper extremities
Full details

Investigations to consider

  • venography
  • biopsy
  • sputum cytology
  • thoracentesis
  • sputum culture
  • erythrocyte sedimentation rate
  • C-reactive protein
Full details

Treatment algorithm

Contributors

Kul Aggarwal

Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

KA declares that he has no competing interests.

Assistant Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

AKC declares that he has no competing interests.

Professor Kul Aggarwal and Dr Albert K Chan would like to gratefully acknowledge Dr Nipun Arora and Lokesh Tejwani, previous contributors to this topic. NA declares that he has no competing interests.

Peer reviewersVIEW ALL

Gill Foundation Professor of Interventional Cardiology

Director of Cardiac Catheterization Laboratories

Gill Heart Institute

Division of Cardiovascular Medicine

University of Kentucky

Lexington

KY

Disclosures

DM declares that he has no competing interests.

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Cardiology Specialist Registrar

The James Cook University Hospital

Middlesbrough

UK

Disclosures

AT declares that he has no competing interests.

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