If SVCO is suspected discuss with an oncologist within 24 hours. The investigation of choice is a CTPA (CT Pulmonary Angiogram). SVCO is usually due to malignant involvement of upper mediastinal lymph nodes or a right upper lobe lung cancer, intraluminal thrombus may also be a feature.
Symptoms and signs: headache; breathlessness; swelling of face and arms; fixed raised JVP; dilated veins on chest wall and around costal margin.
Initial treatment consists of dexamethasone 16 mg daily orally aiming to reduce any oedema around the tumour. Definitive treatment may include insertion of a vascular stent, radiotherapy or chemotherapy.