Oncological emergencies (except neutropenic sepsis!) Spinal cord compression

Superior Vena Cava Obstruction

• SYMPTOMS:

• Swelling of face, neck one or both arms.

• (one arm suggests more distal)

• Distended veins.

• Shortness of breath.

• Headache.

• Lethargy.

Superior Vena Cava Obstruction

Superior Vena Cava Obstruction

• SIGNS:

• Early stage: puffy neck, neck veins don’t collapse.

• Later:

• Distended neck & chest wall
• veins.
• Swollen face, neck and arms.

• In advanced cases:

• Injected conjunctiva.
• Sedation.

Superior Vena Cava Obstruction

• Main aim is to distinguish whether obstruction is blockage from within:

• Clot (DVT) – often fast onset.
• Foreign body (e.g.line).
• Tumour in vessel (e.g. renal cancer).

• Or without:

• Extrinsic compression from mass.

History

• How long?

• Speed of onset?

• How advanced? If patient is becoming drowsy this is an emergency.

• Any risk factors e.g. recent central line.

• Any symptoms of cancer esp. lung cancer or lymphoma.

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