HISTORY: 

59-year-old woman with peptic ulcer disease with an associated jejunal ulcer and recent hematochezia abd hypotension.  Evaluate for site of active bleeding.  She has a known superior vena cava obstruction just inferior to the azygos arch.  She also has pancreatic cancer, status post resection, chemotherapy, and radiation.

DISCUSSION:

Superior vena cava syndrome usually results from direct compression of the superior vena cava secondary to adjacent masses.  The most common cause of superior vena cava obstruction is bronchogenic carcinoma.  Other malignancies, such as lymphoma, can also cause superior vena cava obstruction.  Primary mediastinal masses, such as those of thymic origin, can also result in obstruction of the superior vena cava.  Thrombosis, usually secondary to intravascular devices, is the most common non-compressive etiology of superior vena cava syndrome.  Patients usually present with shortness of breath, as well as facial and/or upper extremity swelling.  Diagnosis is typically confirmed with contrast enhanced computed tomography, although conventional angiography or magnetic resonance angiography could also be utilized.  Treatment usually involves surgical resection, medical therapy, usually in the form of steroids, to decrease the amount of inflammation, or radiation to decrease the size of the obstructing mass.  Symptomatic treatment often involves diuretics to decrease the amount of swelling.  Prognosis in cases where tumor is the cause is poor, as superior vena cava syndrome typically indicates an advanced stage of malignancy.