Key Points
- Confirm diagnosis early with highest‑yield tests (and do not let testing delay time‑critical therapy).
- Use explicit hemodynamic, respiratory, and neurologic targets to guide escalation.
- Document disposition criteria, follow‑up, and patient education before discharge.
Algorithm
- Rapid assessment: airway (stridor), cerebral edema signs, hemodynamics.
- Elevate head, supplemental oxygen; avoid diuretics unless volume overloaded.
- CT chest with contrast to define obstruction; coordinate biopsy route.
- If unstable airway/brain edema → urgent stent and disease‑directed therapy.
- Plan endovascular stenting for symptomatic relief when feasible.
- Initiate anticoagulation if thrombus present and not contraindicated.
- Start disease‑specific therapy (chemo/RT) after tissue diagnosis.
- Close follow‑up for recurrence; manage stent patency and tumor response.
Clinical Synopsis & Reasoning
Dyspnea, facial and upper‑extremity swelling, and venous distension from malignant obstruction are classic. Assess airway and hemodynamics; obtain tissue diagnosis before radiation when feasible. Endovascular stenting offers rapid relief; adjunct steroids are disease‑specific (e.g., lymphoma).
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced or procedural interventions when predefined failure criteria are met. Define ICU, step‑down, and ward disposition triggers explicitly, and arrange specialty consultation early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context‑specific | Trend response |
| BMP | Electrolytes/renal | Derangements common | Renal dosing/monitoring |
| Condition‑specific imaging | Per topic | Diagnostic hallmark | Do not delay with red flags |
| CT chest with contrast | Anatomy/etiology | SVC narrowing/obstruction | Plan stent route/biopsy |
| Coagulation/duplex ultrasound | Thrombotic component | Venous thrombosis | Anticoagulation when indicated |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Endovascular stent | Mechanical patency | Immediate | Rapid symptom relief | Restenosis risk; anticoagulate as indicated |
| Dexamethasone (selected tumors) | Glucocorticoid | Hours | Edema reduction (e.g., lymphoma) | Hyperglycemia |
| Anticoagulation (if thrombotic) | Anticoagulant | Immediate | Treat thrombus/maintain patency | Bleeding risk |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and the follow‑up plan; provide written instructions.
References
- See bibliography — Link