30th December 2024

Clinical features of SVCO

The signs and symptoms of SVCO (Table 12) are related to the back pressure in veins draining into the SVC.

Symptoms of SVCO

Patients may describe facial swelling and redness that may be worse in the mornings and when bending forward (due to poor venous return from the head and neck) and may improve on standing/sitting up due to gravity. These symptoms may be associated with a sense of pressure or discomfort.

They may have noticed progressive venous distension, or new veins, in their head, neck and upper chest.

The patient may have shortness of breath if there is associated laryngeal oedema or airway compression. There may be headache, nausea and, in some cases, confusion related to cerebral oedema.

Of note, there may be a subacute presentation, and patients may have noticed improvement in symptoms after a period of 2-3 weeks – once venous collaterals have been recruited.

Signs of SVCO

The patient may be plethoric in the head, neck and upper chest with or without associated oedema and distended veins. If there is laryngeal or bronchial oedema, stridor may be heard and the patient may be visibly dyspnoeic or cyanosed. If cerebral oedema has developed, papilloedema may be present.

Classically, there is a positive Pemberton’s sign: on holding both arms above their head for 2 minutes there is worsening plethora, venous distension, cyanosis and/or respiratory distress.