2. ANATOMY
SVC formed by union of Right & Left
Brachiocephalic vein.
Extent b/w 1st
to 3rd
costal cartilage
receives the azygos vein immediately
before entering the pericardial sac
Venous blood from head/neck/upper
extremities
6 to 8 cm in length &1.5 to 2 cm wide
3. ANATOMY
• SVC surrounded by rigid structures (ie
mediastinum, sternum, right mainstem
bronchus and LN)
• Thin walled and easily compressible
secondary to low pressure
• Prone to obstruction relative to its
“neighbours”
6. SVC Syndrome
• Constellation of signs and symptoms
caused by obstruction of blood flow in
the superior vena cava.
• Secondary to external compression,
invasion, constriction or thrombosis of
the SVC
• Can be partial or complete obstruction
7. SCVS (cont)
• Leads to increased venous pressure and
results in edema of the head, neck, arms,
and upper chest
• Dilated veins on the chest wall
• Pleural/pericardial effusions
• Cerebral edema/Increased IC pressure
8. Clinical Features of SVC
SYMPTOMS
Facial swelling Headache
Short of Breath Diziness
Chest Pain Tinitus
Cough Brusting sensation
Dysphagia Nasal congestion
Horseness of voice
MEN 1st
SYMPTOM = collar size
10. Clinical Features of SVCS
SIGNS
Edema & Plethora of face, neck,
arm,ant chest wall.
Neck vein distension(non pulsatile)
Venous collateral over ant chest wall
cyanosis,conj congestion,Proptosis
CNS = headache ,visual
disturbance,papilledema
Downhill Esophageal varices
Pleural effusion 25%
11. Site of esophageal varices indicate
site of SVC obstruction
• Varices in upper 1/3
SVCO proximal to azygos vein
• Varices in entire esophagus
SVCO involve or distal to
azygos vein
13. • As obstruction develops, venous
collaterals form
• Alternate pathways for venous return to
the RA
• Severity of symp depends on the time
course of obstruction
• Mass b/w 1st
& 3rd
rib can cause SVCO
Applied antomy
20. Chest Radiograph
• CXR FINDINGS FREQUENCY
• Mediastinal Mass
• or Widening 59-84%
• Hilar LAD 19-50%
• Pleural Effusions 25%
• Normal chest X-ray does not exclude
SVCO
21. Venography
• Can give precise level of obstruction
• Less information on etiology of SVCS
• Requires larger contrast dose
22. CT/MRI/MRV
• Provide accurate info on location
obstruction
• Determine etiology of obstruction
• Info on the extent of collaterals
• Guide biopsy attempts
26. Which First---> Tx or Dx?
OLD CONCEPT
SVCO =ONCOLOGICAL EMERGENCY
can cause cerebral venous thrombosis
T.O.C= Very high dose RT 3000-4000
Rads for 4 days
NOW A DAYS
TISSUE DIAGNOSIS is given importance
before starting T/t(Prev chemo/RT alter
Histoplogy)
35. HISTORY
• First description of
superior sulcus
tumours was given
by
Edward Selleck Hare
in 1838.
• Henry Khunrath Pancoast
, a radiologist in
Philadelphia, first
described the
syndrome in 1932
36. Pancoast tumours arise in lung
apex, and may invade
• Parietal pleura.
• Endothoracic fascia.
• First, second and third ribs.
• C8, T1 & T2 nerve roots (as they pass
over first rib) of brachial plexus
(brachial plexopathy).
• Intercostal nerves.
37. Cont….
• Stellate (inferior cervical) ganglion and
paravertebral cervical sympathetic
chain (at or above T1 level).
• Subclavian vessels.
• Bodies and transverse processes of
adjacent vertebras.
• Endothoracic lymphatics
38. Staging
• Staging of NSCLC Pancoast tumor: At
least T3 disease
• Stage IIB (T3N0) or
• Stage IIIA (T3N1-2, or T4N0-1), or
• Stage IIIB (T4N2).
39. Pancoast syndrome is
characterized by
pain in shoulder, upper anterior chest
wall, interscapular region, or neck
Horner’s syndrome,
Wasting and weakness of the ipsilateral
intrinsic hand musculatures
40. PAIN
• pain in shoulder, upper anterior chest
wall, interscapular region, or neck and
• the pain characteristically radiates to
along ulnar aspect of the upper limb,
extending upto fourth and fifth digits
(C8 – T2 segmental distribution).
41. Horner’s syndrome
Horner’s syndrome, comprised of
• ipsilateral partial ptosis,
• meiosis,
• enophthalmos,
• anhydrosis, and
• loss of ciliospinal reflex, results from
invasion of the stellate ganglion and
paravertebral cervical sympathetic
chain.
42. Wasting and weakness hand
musculature
• Wasting and weakness of the ipsilateral
intrinsic hand musculature, and medial
forearm wrist and finger flexors,
sensory loss and parasthesias (tingling
& numbness) along medial border of
arm, forearm, fourth and fifth digits are
resulted from invasion of C8, T1 and T2
nerve roots of the brachial plexus