Summary
Definition
History and exam
Key diagnostic factors
- history of cancer
- localized edema of the face and upper extremities
- dyspnea
- facial plethora
- cough
- distended neck veins
- distended chest veins
- hoarseness of voice
- lymphadenopathy
- blurred vision
- stridor
- confusion/stupor
Other diagnostic factors
- headache
- mental changes
- laryngeal edema
- cyanosis
- papilledema
- coma
Risk factors
- lung cancer
- lymphoma
- multiple pacemaker leads
- central venous catheters/ports
- thymoma
- germ cell tumor
- metastatic solid organ cancer
- radiation
Diagnostic tests
1st tests to order
- chest CT with intravenous contrast
- chest CT angiography and venography with intravenous contrast
- chest MRI with intravenous contrast
- chest MR angiography and venography with or without intravenous contrast
Tests to consider
- chest x-ray
- venography
- biopsy
- sputum cytology
- thoracentesis
- sputum culture
- erythrocyte sedimentation rate
- C-reactive protein
Treatment algorithm
acute airway obstruction (without tissue diagnosis)
malignant etiology
infectious etiology
iatrogenic etiology
Contributors
Authors
Albert K. Chan, MD
Associate Professor of Clinical Medicine
University of Missouri
Columbia, MO
Disclosures
AKC declares that he has no competing interests.
Acknowledgements
Dr Albert K Chan would like to gratefully acknowledge Dr Nipun Arora, Lokesh Tejwani, and the late Professor Kul Aggarwal for their previous contributions to this topic. NA, LT, and KA declared no competing interests.
Peer reviewers
Debabrata Mukherjee, MD
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.
Syed Wamique Yusuf, MD, MRCPI, FACC
Associate Professor
University of Texas MD Anderson Cancer Center
Department of Cardiology
Houston, TX
Disclosures
SWY declares that he has no competing interests.
Andrew Turley, MB ChB
Cardiology Specialist Registrar
The James Cook University Hospital
Middlesbrough
UK
Disclosures
AT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Wilson LD, Detterbeck FC, Yahalom J. Clinical practice: superior vena cava syndrome with malignant causes. N Engl J Med. 2007 May 3;356(18):1862-9. Abstract
Azizi AH, Shafi I, Shah N, et al. Superior vena cava syndrome. JACC Cardiovasc Interv. 2020 Dec 28;13(24):2896-910.Full text Abstract
American College of Radiology. ACR appropriateness criteria: thoracic venous occlusions-suspected superior vena cava syndrome. 2025 [internet publication].Full text
Uberoi R. Quality assurance guidelines for superior vena cava stenting in malignant disease. Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):319-22. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Cardiac tamponade
- Constrictive pericarditis
- Acute COPD exacerbation
More DifferentialsGuidelines
- ACR appropriateness criteria: thoracic venous occlusions-suspected superior vena cava syndrome
- ACR appropriateness criteria: thoracic venous occlusions-suspected superior vena cava syndrome
More Guidelines
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