Synopsis
Recognise dangerous upper-body venous congestion, define tumour and thrombus rapidly and coordinate airway, stenting, cancer treatment and device-associated thrombosis care.
- SVC obstruction is usually caused by intrathoracic malignancy, but central venous catheters, pacemaker/ICD leads and other devices increasingly cause or contribute to central thrombosis.
- Facial/neck and bilateral arm swelling, venous plethora and dilated chest-wall collaterals that worsen lying flat or bending forward are classic.
- Stridor, confusion, reduced consciousness, syncope or haemodynamic compromise marks severe obstruction and requires immediate multidisciplinary escalation.
Key red flags
Stridor, laryngeal oedema, inability to lie flat, severe work of breathing or rapidly increasing neck swelling requires immediate airway/critical-care and interventional discussion.
Investigation priorities
Confirm the site/severity of obstruction and distinguish external compression, tumour invasion and intraluminal thrombus.
Management branches
Stridor/laryngeal oedema, severe distress, confusion/reduced consciousness, syncope/hypotension or rapidly progressive obstruction.
- First: sit upright, monitor continuously, give oxygen if hypoxaemic and summon senior anaesthetic/critical-care support; avoid sedation and unnecessary upper-limb cannulation where feasible.
- Next: contact acute oncology/respiratory and interventional radiology immediately; obtain contrast CT only when the airway and circulation are sufficiently stable.
Clinical SVC obstruction without immediate airway, cerebral or circulatory compromise.
Key medicines
Dexamethasone8 mg orally twice daily, in the morning and at lunchtime; use IV administration at the same dose when swallowing is unsafe or impossible.
Omeprazole20 mg orally once daily while high-dose dexamethasone is used when gastroprotection is indicated.