Superior Vena Cava Obstruction

In the current era of increased availability and frequency of surveillance imaging for oncology patients, superior vena caval obstruction (SVCO) is often an incidental finding in asymptomatic patients. Less commonly, SVCO may present with advanced symptomatology, and in these cases, the SVCO may represent rapid disease progression and/or the first presentation of malignancy. Contrast-enhanced computed tomography (CT) is exceptionally useful for the diagnosis of SVCO and often reveals extrinsic compression by mediastinal lymphadenopathy as the more common mechanism for malignant SVCO. Non-small cell and small cell lung cancers constitute the more common histologies, with metastatic mediastinal lymphadenopathy or direct mediastinal invasion causing the SVCO. Radiotherapy is the traditional treatment of choice for patients with SVCO. For patients with severe symptoms, treatment of SVCO constitutes a medical emergency and requires urgent treatment with endovascular stenting to restore patency and produce rapid relief of potentially life-threatening symptoms.