Partial Obstruction of the Superior Vena Cava

Archie R McGowan, MD
Robert D Pugatch, MD

April 2, 1996

Presentation

A 44-year-old man presented for evaluation of facial swelling.

Imaging Findings

Plain radiograph of the chest

Contrast-enhanced CT

Chest radiography reveals a widened superior mediastinum (arrow), for which the patient was referred for a chest CT.

Contrast-enhanced spiral volumetric computed tomography (CT) of the chest was done with 10mm slices. A large soft tissue mass surrounds the vascular structures in the anterior and middle mediastinum (arrow). The mass enhances inhomogeneously. The left innominate vein is narrowed as it enters the superior vena cava (SVC) (arrow). The SVC is almost totally occluded.

Diagnosis

Superior vena cava obstruction secondary to large cell lymphoma

Discussion

The superior vena cava (SVC) is typically 1.5 to 2 cm in diameter and 7 cm in length. It occupies a relatively fixed position in the right anterior mediastinum. The lower half is covered by the parietal pericardium. The SVC is subject to compression because of its thin wall and low internal pressures. A recent review revealed that SVC syndrome is now "almost synonymous with malignancy." Malignant causes are: 82% bronchogenic carcinoma, 12% lymphoma and 6% metastatic disease (1).

However, Shimm et al (2) found that only 5 to 15% of lung cancers, 5% of lymphomas and 1% of metastatic disease result in SVC syndrome. While SVC syndrome is most commonly a result of malignancy, it is still a relatively uncommon paraneoplastic event.

In the future, iatrogenic causes will significantly increase due the increasing use of venous access catheters and the incidence of catheter-induced thrombosis.

References

1. Yedlicka JW, et al. CT findings in superior vena cava obstruction. Semin Roentgenol 1989;24(2):84-90.

2. Shimm DB, et al. Evaluating the superior vena cava syndrome. JAMA 1981;245: 951-953.

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